Provider Demographics
NPI:1447220553
Name:DERMODY, RACHELLE ARSENEAU (DMD)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ARSENEAU
Last Name:DERMODY
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 1:1100 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1780
Mailing Address - Country:US
Mailing Address - Phone:772-879-1879
Mailing Address - Fax:772-879-2101
Practice Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1780
Practice Address - Country:US
Practice Address - Phone:772-879-1879
Practice Address - Fax:772-879-2101
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN144181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry