Provider Demographics
NPI:1669581831
Name:STOCKHAUSEN, RACHEL MARGARET (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARGARET
Last Name:STOCKHAUSEN
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37641 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-744-9447
Mailing Address - Fax:734-744-9446
Practice Address - Street 1:37641 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-744-9447
Practice Address - Fax:734-744-9446
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010185121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice