Provider Demographics
NPI:1770303786
Name:NETHERCUTT, RAEANN LEE (RDH)
Entity type:Individual
Prefix:
First Name:RAEANN
Middle Name:LEE
Last Name:NETHERCUTT
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 1:1097 W MT CALVARY RD
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-8464
Mailing Address - Country:US
Mailing Address - Phone:219-208-0356
Mailing Address - Fax:
Practice Address - Street 1:1435 UNION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2059
Practice Address - Country:US
Practice Address - Phone:765-423-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13006244A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist