Provider Demographics
NPI:1306915970
Name:IFILL, RACHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:IFILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:VALCIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9554 YELLOW FINCH CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8551
Mailing Address - Country:US
Mailing Address - Phone:734-649-6177
Mailing Address - Fax:
Practice Address - Street 1:2545 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:LEOMA
Practice Address - State:TN
Practice Address - Zip Code:38468-5310
Practice Address - Country:US
Practice Address - Phone:931-851-9000
Practice Address - Fax:931-851-9001
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4932478Medicaid