Provider Demographics
NPI:1477377307
Name:GASS, RACHEL (RDH)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GASS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2445
Mailing Address - Country:US
Mailing Address - Phone:309-360-8335
Mailing Address - Fax:
Practice Address - Street 1:712 SPRING ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2445
Practice Address - Country:US
Practice Address - Phone:309-360-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.012415124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist