Provider Demographics
NPI:1588142020
Name:BLACK, RACHEL M (DMD, DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:M
Last Name:BLACK
Suffix:
Gender:F
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 E 98TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1973
Mailing Address - Country:US
Mailing Address - Phone:317-843-1281
Mailing Address - Fax:317-574-9390
Practice Address - Street 1:3003 E 98TH ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1973
Practice Address - Country:US
Practice Address - Phone:317-843-1281
Practice Address - Fax:317-574-9390
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013027A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics