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General NPI Number Information
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NPI Number | 1407417140
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Entity Type | Individual
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Provider Name | REBECCA PETTS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 9601 CHESTER AVE
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-368-8665
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Fax |
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Provider Business Mailing Address
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Address Line | 30842 KILGOUR DR
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City | WESTLAKE
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State | OH
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Zip | 44145-6835
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Country | US
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Telephone | 440-226-0097
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | RES.004157
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License Number State | OH
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