=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114412855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL GIOVANNINI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2018
-----------------------------------------------------
Last Update Date | 05/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9280 MAIN ST
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-741-9774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9280 MAIN ST
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-741-9774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 059733
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------