MEDICARE: MRS. REBEL LEE CHAPA R.D.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	13963	TX

General Provider Information

NPI Number	:	1780715920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBEL LEE CHAPA R.D.H.

Provider Business Mailing Address
First Line	:	401 W SYCAMORE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-6043
Country	:	US
Telephone Number	:	817-437-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 LONG PRAIRIE RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2294
Country	:	US
Telephone Number	:	972-316-6320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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