Provider Demographics
NPI:1144531922
Name:MICHALAK, RACHAEL LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:LEIGH
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12130 PEBBLE HILLS BLVD APT H305
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1032
Mailing Address - Country:US
Mailing Address - Phone:419-367-0445
Mailing Address - Fax:
Practice Address - Street 1:2138 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5131
Practice Address - Country:US
Practice Address - Phone:419-241-1644
Practice Address - Fax:419-249-6581
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023249122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice