Provider Demographics
NPI:1548303415
Name:DEAVILA, RACHEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:R
Last Name:DEAVILA
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 1:5336 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1903
Mailing Address - Country:US
Mailing Address - Phone:602-336-1111
Mailing Address - Fax:602-249-3653
Practice Address - Street 1:1422 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2177
Practice Address - Country:US
Practice Address - Phone:602-336-1111
Practice Address - Fax:602-249-3653
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice