Healthcare Provider Details

I. General information

NPI: 1174322762
Provider Name (Legal Business Name): REBIS THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 DRY CREEK DR STE 200
LONGMONT CO
80503-6409
US

IV. Provider business mailing address

1630 DRY CREEK DR STE 200
LONGMONT CO
80503-6409
US

V. Phone/Fax

Practice location:
  • Phone: 720-279-9098
  • Fax: 303-248-3589
Mailing address:
  • Phone: 720-279-9098
  • Fax: 303-248-3589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ADAM TROY WERTZ
Title or Position: CEO
Credential:
Phone: 720-938-6918