Basic Information
| Provider Information | |||||||||
| NPI: | 1679059331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | RACHELLE | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7003 S MUDLEN ST | ||||||||
| Address2: | |||||||||
| City: | CHENEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990049395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092899837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 123 N BROWER ST | ||||||||
| Address2: | |||||||||
| City: | MEDICAL LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990225109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092995171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2018 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE60861772 | WA | Y | Dental Providers | Dentist | General Practice |
No ID Information.