Healthcare Provider Details

I. General information

NPI: 1669170825
Provider Name (Legal Business Name): REBEKAH BRANSCUM DRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8536 W HIGHWAY 80
NANCY KY
42544-7744
US

IV. Provider business mailing address

8536 W HIGHWAY 80
NANCY KY
42544-7744
US

V. Phone/Fax

Practice location:
  • Phone: 606-636-4311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: GREG WHITE
Title or Position: CEO
Credential:
Phone: 859-533-1109