=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801037924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER R. REBOL, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2009
-----------------------------------------------------
Last Update Date | 03/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 DOCTORS PARK STE F
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-4532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-253-5878
-----------------------------------------------------
Fax | 828-252-1355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 DOCTORS PARK STE F
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-4532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-253-5878
-----------------------------------------------------
Fax | 828-252-1355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. KATHERINE M REBOL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-253-5878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7798
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------