Provider Demographics
NPI:1699914531
Name:TER HAAR, RACHELLE FAE (DH)
Entity type:Individual
Prefix:MISS
First Name:RACHELLE
Middle Name:FAE
Last Name:TER HAAR
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 COLLEGE PKWY APT 727
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2887
Mailing Address - Country:US
Mailing Address - Phone:616-886-6357
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD STE 100
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5029
Practice Address - Country:US
Practice Address - Phone:469-635-1105
Practice Address - Fax:972-316-6029
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15498124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist