Provider Demographics
NPI:1790127892
Name:RACHELS, SCOTT WUNDERLICH JR
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WUNDERLICH
Last Name:RACHELS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W CALDWELL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2910
Mailing Address - Country:US
Mailing Address - Phone:615-754-5840
Mailing Address - Fax:
Practice Address - Street 1:40 W CALDWELL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2910
Practice Address - Country:US
Practice Address - Phone:615-754-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN97061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice