Provider Demographics
NPI:1114540820
Name:DUCKWORTH, RACHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:DUCKWORTH
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 1:4306 RIVER BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2514
Mailing Address - Country:US
Mailing Address - Phone:813-340-2861
Mailing Address - Fax:
Practice Address - Street 1:775 N FERDON BLVD STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2167
Practice Address - Country:US
Practice Address - Phone:850-613-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007297-C1122300000X
FLDN24853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist