Basic Information
| Provider Information | |||||||||
| NPI: | 1881115186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUVAL | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | JOHANNA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23229 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292243229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864889927 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4323 HILL STREET | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516213 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2017 | ||||||||
| LastUpdateDate: | 06/28/2017 | ||||||||
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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 | 122300000X | 0401415694 | VA | Y | Dental Providers | Dentist |
No ID Information.