Provider Demographics
NPI:1891950358
Name:SPICOLA, RACHEL R W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:R W
Last Name:SPICOLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:WARD ROYAL
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11258 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9762
Mailing Address - Country:US
Mailing Address - Phone:813-814-4309
Mailing Address - Fax:
Practice Address - Street 1:11258 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9762
Practice Address - Country:US
Practice Address - Phone:813-814-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist