Healthcare Provider Details

I. General information

NPI: 1407854102
Provider Name (Legal Business Name): REBECCA A FACY M.D.,D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CHAPEL HILLS DR #300
COLORADO SPRINGS CO
80920-1022
US

IV. Provider business mailing address

595 CHAPEL HILLS DR #300
COLORADO SPRINGS CO
80920-1022
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-0500
  • Fax: 719-599-0575
Mailing address:
  • Phone: 719-599-0500
  • Fax: 719-599-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8955
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: