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General NPI Number Information
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NPI Number | 1003058116
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Entity Type | Organization
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Legal Business Name | RACHEL PACKER DDS PC
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 2700 E BRIDGE ST STE 201
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City | BRIGHTON
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State | CO
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Zip | 80601-2561
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Country | US
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Telephone | 303-659-7700
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Fax | 303-659-7190
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Provider Business Mailing Address
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Address Line | 17012 PARKSIDE DR S
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City | COMMERCE CITY
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State | CO
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Zip | 80022-0547
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Country | US
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Telephone | 303-286-4382
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. RACHEL PACKER
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Credential | D.D.S.
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Telephone | 303-286-4382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8466
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 105855
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8499
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License Number State | CO
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