=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437900420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RACHEL PAPPAS, DDS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2024
-----------------------------------------------------
Last Update Date | 03/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4815 N DAMEN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-7825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-417-8898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 W BERTEAU AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-6781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-417-8898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RACHEL PAPPAS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 734-417-8898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------