Provider Demographics
NPI:1730538224
Name:GOAD, RACHEL MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:GOAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:GASAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4921 STATE ROAD 26 E
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4608
Mailing Address - Country:US
Mailing Address - Phone:765-807-0592
Mailing Address - Fax:765-269-7696
Practice Address - Street 1:4921 STATE ROAD 26 E
Practice Address - Street 2:SUITE #100
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4608
Practice Address - Country:US
Practice Address - Phone:765-807-0592
Practice Address - Fax:765-269-7696
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012470A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist