Healthcare Provider Details

I. General information

NPI: 1578558367
Provider Name (Legal Business Name): RACHEL MYAING-MISFELDT D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL NAPLES DENRAL CLINIC, PSC 827
FPO AE
09617
IT

IV. Provider business mailing address

2124 SAND DOLLAR DR BAYFRONT
RICHMOND CA
94804-7483
US

V. Phone/Fax

Practice location:
  • Phone: 390818116008
  • Fax:
Mailing address:
  • Phone: 510-620-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: