Provider Demographics
NPI:1053449165
Name:HIMM, REBECCA WATSON (DDS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:WATSON
Last Name:HIMM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16824 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1600
Mailing Address - Country:US
Mailing Address - Phone:734-421-0121
Mailing Address - Fax:734-421-0121
Practice Address - Street 1:30737 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3376
Practice Address - Country:US
Practice Address - Phone:248-476-9191
Practice Address - Fax:248-476-4599
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID194010OtherBLUE CROSS BLUESHIELD PIN