Healthcare Provider Details

I. General information

NPI: 1396774816
Provider Name (Legal Business Name): RACHEL HARDIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N. ALLEN STREET
CENTRALIA MO
65240
US

IV. Provider business mailing address

102 N. ALLEN STREET
CENTRALIA MO
65240
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-2015
  • Fax: 573-682-1007
Mailing address:
  • Phone: 573-682-2015
  • Fax: 573-682-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2006015344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: