MEDICARE: DR. RACHELLE CHAIKIN DDS

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	122300000X	Dentist	9853	CO
2	122300000X	Dentist	DD3274	NM

General Provider Information

NPI Number	:	1366415853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHELLE CHAIKIN DDS

Provider Business Mailing Address
First Line	:	13 E AVENIDA SEBASTIAN
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506
Country	:	US
Telephone Number	:	719-588-6452
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 E AVENIDA SEBASTIAN
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506
Country	:	US
Telephone Number	:	719-588-6452
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	01/12/2011

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