Healthcare Provider Details

I. General information

NPI: 1215664107
Provider Name (Legal Business Name): REBECCA WEIGHTMAN, DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 LOCUST ST STE 200
PASADENA CA
91101-4457
US

IV. Provider business mailing address

747 LOCUST ST STE 200
PASADENA CA
91101-4457
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-5361
  • Fax: 626-796-3857
Mailing address:
  • Phone: 626-796-3857
  • Fax: 626-796-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: EVETTE L BOWDEN
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 626-796-5361