Provider Demographics
NPI:1033592100
Name:GREEN, REBECCA BISHOP (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BISHOP
Last Name:GREEN
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 1:409 ETTER DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1073
Mailing Address - Country:US
Mailing Address - Phone:859-887-1094
Mailing Address - Fax:859-885-1604
Practice Address - Street 1:409 ETTER DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1073
Practice Address - Country:US
Practice Address - Phone:859-887-1094
Practice Address - Fax:859-885-1604
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY96321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice