Provider Demographics
NPI:1760819395
Name:O'BRIEN, RACHAEL ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:ELAINE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4425
Mailing Address - Country:US
Mailing Address - Phone:469-569-5429
Mailing Address - Fax:
Practice Address - Street 1:2827 RED OAK DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4425
Practice Address - Country:US
Practice Address - Phone:469-569-5429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist