Provider Demographics
NPI:1922084201
Name:TINGEN, RACHAEL H (DMD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:H
Last Name:TINGEN
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 1:3 HOMESTEADS RD
Mailing Address - Street 2:BLDG. B
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043
Mailing Address - Country:US
Mailing Address - Phone:505-771-1122
Mailing Address - Fax:505-771-1144
Practice Address - Street 1:3 HOMESTEADS RD
Practice Address - Street 2:BLDG. B
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043
Practice Address - Country:US
Practice Address - Phone:505-771-1122
Practice Address - Fax:505-771-1144
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD2324OtherDENTAL LICENSE