Healthcare Provider Details

I. General information

NPI: 1881665008
Provider Name (Legal Business Name): RACHEL LYNN WITHERSPOON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDING OFFICER US NAVAL HOSPITAL ATTN. DENTAL CLINIC
FPO AE
09589-1000
US

IV. Provider business mailing address

PSC 1005 BOX 25
FPO AE
09593
US

V. Phone/Fax

Practice location:
  • Phone: 011539972241
  • Fax:
Mailing address:
  • Phone: 01153997154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number003334
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: