Healthcare Provider Details

I. General information

NPI: 1902507411
Provider Name (Legal Business Name): REBECA G. ATKINS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. REBECA G CARRANZA ATKINS

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 06/18/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 HARVARD AVE APT 1705
DALLAS TX
75205-3733
US

IV. Provider business mailing address

3140 HARVARD AVE APT 1705
DALLAS TX
75205-3733
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39659
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: