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General NPI Number Information
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NPI Number | 1649691049
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Entity Type | Organization
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Legal Business Name | RACHEL C. WOLL, D.D.S., P.C.
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 312 E 3RD ST
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City | ROYAL OAK
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State | MI
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Zip | 48067-2726
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Country | US
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Telephone | 248-336-7900
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Fax | 248-336-7900
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Provider Business Mailing Address
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Address Line | 312 E 3RD ST
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City | ROYAL OAK
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State | MI
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Zip | 48067-2726
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Country | US
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Telephone | 248-336-7900
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Fax | 248-336-7900
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Authorized Official
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Title or Position | OWNER
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Name | DR. RACHEL CARRIE WOLL
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Credential | D.D.S.
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Telephone | 248-336-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 17531
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License Number State | MI
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