=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053870287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAHOE ORAL SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2019
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40165 TRUCKEE AIRPORT RD STE 303
-----------------------------------------------------
City | TRUCKEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96161-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-541-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40165 TRUCKEE AIRPORT RD STE 303
-----------------------------------------------------
City | TRUCKEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96161-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-541-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL PARTNER
-----------------------------------------------------
Name | DR. RACHEL LYNNE APPELBLATT
-----------------------------------------------------
Credential | DDS MD
-----------------------------------------------------
Telephone | 916-296-9006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------