Provider Demographics
NPI:1831645951
Name:LEO FLAGG, RACHEL (RDH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LEO FLAGG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7425
Mailing Address - Country:US
Mailing Address - Phone:603-271-6484
Mailing Address - Fax:
Practice Address - Street 1:31 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7425
Practice Address - Country:US
Practice Address - Phone:603-271-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01964124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01964OtherLICENSE