Provider Demographics
NPI:1891356564
Name:BAGOT, RACHEL ERIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ERIN
Last Name:BAGOT
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 1:2323 LOCUST ST APT 509
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1539
Mailing Address - Country:US
Mailing Address - Phone:573-225-1519
Mailing Address - Fax:
Practice Address - Street 1:441 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-5603
Practice Address - Country:US
Practice Address - Phone:314-312-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist