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NPI Code Detail

MEDICARE: DR. RACHAEL D GANDOLPH DDS

MEDICARE: DR. RACHAEL D GANDOLPH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2006015360MO
2122300000XDentist12011087AIN
3122300000XDentist60388KS

General Provider Information

NPI Number : 1235158221
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RACHAEL D GANDOLPH DDS
Provider Business Mailing Address
First Line : 3403 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-989-7562
Fax Number :
Provider Business Practice Location Address
First Line : 2340 E 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-2008
Country : US
Telephone Number : 317-782-2127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 02/17/2023

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Directions to “ DR. RACHAEL D GANDOLPH DDS” Practice Location

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