Provider Demographics
NPI:1205064409
Name:FANNING, RACHEL HARMS (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:HARMS
Last Name:FANNING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 EAKES RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5529
Mailing Address - Country:US
Mailing Address - Phone:573-230-7237
Mailing Address - Fax:
Practice Address - Street 1:3901 GEORGIA ST NE
Practice Address - Street 2:SUITE C4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1359
Practice Address - Country:US
Practice Address - Phone:505-884-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist