Provider Demographics
NPI:1366148975
Name:AMSEL, RACHEL M (DDS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:AMSEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:STONY BROOK UNIVERSITY SCHOOL OF DENTAL MEDICINE
Mailing Address - Street 2:PEDIATRIC DENTAL CLINIC - ROOM 114 ROCKLAND HALL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-632-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program