1275591752 NPI number — RACHEL HOPE THIEBERG DDS MS

Table of content: LATEEFAT EBUDOLA ODUBOTE ARNP, FNP-BC (NPI 1922842525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275591752 NPI number — RACHEL HOPE THIEBERG DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIEBERG
Provider First Name:
RACHEL
Provider Middle Name:
HOPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FROMM
Provider Other First Name:
RACHEL
Provider Other Middle Name:
HOPE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275591752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 COOPER DR # 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYLIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75098-3970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-941-9363
Provider Business Mailing Address Fax Number:
972-941-9364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 COOPER DR # 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYLIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75098-3970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-941-9363
Provider Business Practice Location Address Fax Number:
972-941-9364
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  19 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 995 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)