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General NPI Number Information
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NPI Number | 1053449165
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Entity Type | Individual
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Provider Name | REBECCA WATSON HIMM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 30737 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-3376
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Country | US
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Telephone | 248-476-9191
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Fax | 248-476-4599
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Provider Business Mailing Address
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Address Line | 16824 NEWBURGH RD
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City | LIVONIA
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State | MI
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Zip | 48154-1600
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Country | US
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Telephone | 734-421-0121
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Fax | 734-421-0121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901019401
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License Number State | MI
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