Healthcare Provider Details

I. General information

NPI: 1306271242
Provider Name (Legal Business Name): REBECCA J ROSE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S BUSINESS PARK DR STE A6
OOSTBURG WI
53070-1586
US

IV. Provider business mailing address

215 S 10TH ST
OOSTBURG WI
53070-1366
US

V. Phone/Fax

Practice location:
  • Phone: 920-564-0339
  • Fax:
Mailing address:
  • Phone: 920-838-4141
  • Fax: 920-838-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10800
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10800-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: