Provider Demographics
NPI:1881115186
Name:DUVAL, RACHEL JOHANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JOHANNA
Last Name:DUVAL
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:SMOKE BOMB HILL DENTAL CLINIC 3718 GRUBER ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-396-1571
Mailing Address - Fax:
Practice Address - Street 1:3718 GRUBER RD
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-8934
Practice Address - Country:US
Practice Address - Phone:910-396-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415694122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist