Provider Demographics
NPI:1063086692
Name:LEDERMAN, RACHEL PARK (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:PARK
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14575 NE BEL RED RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3908
Mailing Address - Country:US
Mailing Address - Phone:425-746-6020
Mailing Address - Fax:
Practice Address - Street 1:14575 NE BEL RED RD STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3908
Practice Address - Country:US
Practice Address - Phone:425-746-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611147131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice