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General NPI Number Information
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NPI Number | 1659961597
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Entity Type | Individual
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Provider Name | RACHEL GOODEILL R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 2600 DEKALB AVE
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City | SYCAMORE
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State | IL
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Zip | 60178-3131
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Country | US
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Telephone | 815-677-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 10165 ILLINOIS RT 64
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City | SYCAMORE
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State | IL
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Zip | 60178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020014414
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License Number State | IL
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