Healthcare Provider Details

I. General information

NPI: 1003613431
Provider Name (Legal Business Name): RACHEL PATRICIA GOURLEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL HASLEM DMD

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 HARVEY AVE
CINCINNATI OH
45229-3003
US

IV. Provider business mailing address

PO BOX 634856
CINCINNATI OH
45263-4856
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-6660
  • Fax:
Mailing address:
  • Phone: 513-584-6650
  • Fax: 513-584-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028477
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: