Provider Demographics
NPI:1023450418
Name:BAEK, RACHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:BAEK
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 1:11222 TRIBIANI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7506
Mailing Address - Country:US
Mailing Address - Phone:702-688-2698
Mailing Address - Fax:702-257-6722
Practice Address - Street 1:3417 S JONES BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6784
Practice Address - Country:US
Practice Address - Phone:702-257-6767
Practice Address - Fax:702-257-6722
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist