MEDICARE: DR. RACHEL EA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6995	LA

General Provider Information

NPI Number	:	1053971523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL EA DMD

Provider Business Mailing Address
First Line	:	4740 HOMERDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3211
Country	:	US
Telephone Number	:	419-277-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 JEFFERSON HWY
Second Line	:
City	:	LUTCHER
State	:	LA
Zip	:	70071-5119
Country	:	US
Telephone Number	:	225-304-6342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	12/13/2023

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