Provider Demographics
NPI:1033102777
Name:REBHUN, DONALD GLENN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GLENN
Last Name:REBHUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-1500
Mailing Address - Fax:856-772-0711
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 211
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-1500
Practice Address - Fax:856-772-0711
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021938122300000X
NJ22DI012708001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U24764Medicare UPIN
NJRE187554Medicare ID - Type Unspecified