MEDICARE: RACHEL GASS RDH

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
1	124Q00000X	Dental Hygienist	020.012415	IL

General Provider Information

NPI Number	:	1477377307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL GASS RDH

Provider Business Mailing Address
First Line	:	712 SPRING ST
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-2445
Country	:	US
Telephone Number	:	309-360-8335
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 SPRING ST
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-2445
Country	:	US
Telephone Number	:	309-360-8335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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