Provider Demographics
NPI:1801614730
Name:KELLEY, RACHEL CHRISTINE (RDH, LDH, BSDH)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CHRISTINE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RDH, LDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 CESSNA DR
Mailing Address - Street 2:
Mailing Address - City:BURNS HARBOR
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8741
Mailing Address - Country:US
Mailing Address - Phone:219-381-4306
Mailing Address - Fax:
Practice Address - Street 1:1151 CESSNA DR
Practice Address - Street 2:
Practice Address - City:BURNS HARBOR
Practice Address - State:IN
Practice Address - Zip Code:46304-8741
Practice Address - Country:US
Practice Address - Phone:219-381-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13008217A124Q00000X
IL020.015634124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist