Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 04124 | NH |
Y | 1223E0200X | Endodontist | DN1856335 | MA |
NPI | 1124454665 |
---|---|
Provider Name | Dr. Rachel Garoufalis |
First Address | Portland, ME 04101 |
Second Address | Portland, ME 04101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 05/10/2021 |