Provider Demographics
NPI:1790728814
Name:RACHIELE, DOMINIC P (DMD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:P
Last Name:RACHIELE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 8TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1865
Mailing Address - Country:US
Mailing Address - Phone:610-865-8077
Mailing Address - Fax:610-865-8112
Practice Address - Street 1:1521 8TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1865
Practice Address - Country:US
Practice Address - Phone:610-865-8077
Practice Address - Fax:610-865-8112
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0355841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100511Medicare ID - Type Unspecified
PAU91074Medicare UPIN