Provider Demographics
NPI:1942049010
Name:RAHE, KELSEY KIRSTEN (DMD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:KIRSTEN
Last Name:RAHE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CAREY TRL
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2061
Mailing Address - Country:US
Mailing Address - Phone:630-303-4027
Mailing Address - Fax:
Practice Address - Street 1:2360 THAIN GRADE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4115
Practice Address - Country:US
Practice Address - Phone:208-717-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-56381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice