Healthcare Provider Details

I. General information

NPI: 1114756814
Provider Name (Legal Business Name): RACHEL E RIKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GLEN RD
WESTPORT MA
02790-1380
US

IV. Provider business mailing address

160 PROSPECT ST
HINGHAM MA
02043-3441
US

V. Phone/Fax

Practice location:
  • Phone: 774-930-2052
  • Fax:
Mailing address:
  • Phone: 781-910-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH10378
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: