Provider Demographics
NPI:1154557197
Name:REVELL, RACHAEL ANNE (DDS)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANNE
Last Name:REVELL
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 1:5950 VILLAGE VIEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-3844
Mailing Address - Country:US
Mailing Address - Phone:641-521-0625
Mailing Address - Fax:
Practice Address - Street 1:5950 VILLAGE VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-3844
Practice Address - Country:US
Practice Address - Phone:641-521-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090121223P0221X
TX258471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry