Provider Demographics
NPI:1649691049
Name:RACHEL C. WOLL, D.D.S., P.C.
Entity type:Organization
Organization Name:RACHEL C. WOLL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:CARRIE
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-336-7900
Mailing Address - Street 1:312 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2726
Mailing Address - Country:US
Mailing Address - Phone:248-336-7900
Mailing Address - Fax:248-336-7900
Practice Address - Street 1:312 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2726
Practice Address - Country:US
Practice Address - Phone:248-336-7900
Practice Address - Fax:248-336-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17531261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental