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General NPI Number Information
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NPI Number | 1588890347
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Entity Type | Individual
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Provider Name | REBECCA SUE NEITZKE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 12/17/2023
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Provider Practice Location Address
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Address Line | 8200 E BELLEVIEW AVE STE 426C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2851
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Country | US
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Telephone | 720-649-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 E BELLEVIEW AVE STE 426C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2851
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Country | US
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Telephone | 720-649-0430
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D12680
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D12680
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License Number State | MN
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