Provider Demographics
NPI:1194589010
Name:MAYDEW, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MAYDEW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 BUTTERFLY GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7508
Mailing Address - Country:US
Mailing Address - Phone:614-722-5650
Mailing Address - Fax:
Practice Address - Street 1:380 BUTTERFLY GARDENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7508
Practice Address - Country:US
Practice Address - Phone:614-722-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027820122300000X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry