Provider Demographics
NPI:1033126297
Name:MCDOUGALD, REBECCA SMITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SMITH
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 N GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1220
Mailing Address - Country:US
Mailing Address - Phone:662-844-6420
Mailing Address - Fax:662-844-6421
Practice Address - Street 1:1906 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1220
Practice Address - Country:US
Practice Address - Phone:662-844-6420
Practice Address - Fax:662-844-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2634-911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics