Provider Demographics
NPI:1952346827
Name:ANDRADA-ROSE, RACHEL JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JOY
Last Name:ANDRADA-ROSE
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 1:4350 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9107
Mailing Address - Country:US
Mailing Address - Phone:304-252-0472
Mailing Address - Fax:304-252-1890
Practice Address - Street 1:220 RAGLAND RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9721
Practice Address - Country:US
Practice Address - Phone:304-252-1509
Practice Address - Fax:304-252-1890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 31591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134402001Medicaid