Provider Demographics
NPI:1124451984
Name:ERICKSON, RACHEL BELLA (DMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BELLA
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:BELLA
Other - Last Name:SHEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1224 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1424
Mailing Address - Country:US
Mailing Address - Phone:541-476-3419
Mailing Address - Fax:
Practice Address - Street 1:1224 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1424
Practice Address - Country:US
Practice Address - Phone:541-476-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist