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General NPI Number Information
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NPI Number | 1922621929
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Entity Type | Individual
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Provider Name | REBECCA ROSE RDH
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 1310 BERTHA AVE NW
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City | BREMERTON
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State | WA
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Zip | 98312-2607
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Country | US
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Telephone | 360-620-2130
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1292
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City | SILVERDALE
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State | WA
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Zip | 98383-1292
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Country | US
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Telephone | 360-620-2130
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00006574
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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