Provider Demographics
NPI:1124268453
Name:WADDILL, RACHEL CLAIRE (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:CLAIRE
Last Name:WADDILL
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 1:5440 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2779
Mailing Address - Country:US
Mailing Address - Phone:480-830-3344
Mailing Address - Fax:480-830-4096
Practice Address - Street 1:5440 E SOUTHERN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2779
Practice Address - Country:US
Practice Address - Phone:480-830-3344
Practice Address - Fax:480-830-4096
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist