Provider Demographics
NPI:1467029884
Name:RAUCHLE, ALEX AMMA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:AMMA
Last Name:RAUCHLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1399 SW JULIA ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-5501
Mailing Address - Country:US
Mailing Address - Phone:415-419-4481
Mailing Address - Fax:
Practice Address - Street 1:1608 PENNY LN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4477
Practice Address - Country:US
Practice Address - Phone:415-419-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD115691223X0400X
WADE612306081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics