Provider Demographics
NPI:1962497412
Name:CRESTO, RACHAEL J (DMD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:J
Last Name:CRESTO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:J
Other - Last Name:SCHAWEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1013 W UNIVERSITY AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5345
Mailing Address - Country:US
Mailing Address - Phone:512-869-4850
Mailing Address - Fax:
Practice Address - Street 1:1013 W UNIVERSITY AVE STE 345
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5345
Practice Address - Country:US
Practice Address - Phone:512-869-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9866122300000X
IDD3823122300000X
WADE00010834122300000X
TX30632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UAD000Medicare UPIN