Healthcare Provider Details

I. General information

NPI: 1164849246
Provider Name (Legal Business Name): RACHEL M HARDIN DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N ALLEN ST
CENTRALIA MO
65240-1394
US

IV. Provider business mailing address

102 N ALLEN ST
CENTRALIA MO
65240-1394
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 Code305R00000X
TaxonomyPreferred Provider Organization
License Number2006015344
License Number StateMO

VIII. Authorized Official

Name: DR. RACHEL MICHELLE HARDIN
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 573-682-2015