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General NPI Number Information
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NPI Number | 1972057115
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Entity Type | Individual
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Provider Name | RACHEL NICOLE PRISBE
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Gender | Female
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 38865 DEQUINDRE RD STE 105
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City | TROY
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State | MI
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Zip | 48083-6812
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Country | US
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Telephone | 248-879-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 4049 W MAPLE RD APT A101
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-3114
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Country | US
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Telephone | 586-879-9221
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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 | 2902017691
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License Number State | MI
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