Provider Demographics
NPI:1801275573
Name:RACHAL, MARY WEBSTER (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:WEBSTER
Last Name:RACHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2651
Mailing Address - Country:US
Mailing Address - Phone:318-737-9141
Mailing Address - Fax:
Practice Address - Street 1:518 DURHAM ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5013
Practice Address - Country:US
Practice Address - Phone:318-283-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist