Healthcare Provider Details

I. General information

NPI: 1033102777
Provider Name (Legal Business Name): DONALD GLENN REBHUN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD SUITE 211
VOORHEES NJ
08043-4501
US

IV. Provider business mailing address

2301 E EVESHAM RD SUITE 211
VOORHEES NJ
08043-4501
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-1500
  • Fax: 856-772-0711
Mailing address:
  • Phone: 856-772-1500
  • Fax: 856-772-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS021938
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01270800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: