Healthcare Provider Details

I. General information

NPI: 1467145722
Provider Name (Legal Business Name): RACHEL M WEATHERHEAD DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22150 ALLEN RD STE 1
WOODHAVEN MI
48183-2271
US

IV. Provider business mailing address

22150 ALLEN RD STE 1
WOODHAVEN MI
48183-2271
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-6672
  • Fax:
Mailing address:
  • Phone: 734-676-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL WEATHERHEAD
Title or Position: OWNER / DENTIST
Credential: DDS
Phone: 734-676-6672