Provider Demographics
NPI:1821542119
Name:SELLS, RACHAEL MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:MARIE
Last Name:SELLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W LOSEY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225-5250
Mailing Address - Country:US
Mailing Address - Phone:618-256-0995
Mailing Address - Fax:
Practice Address - Street 1:36 MDG UNIT 14010
Practice Address - Street 2:BUILDING 26001
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-366-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist