Provider Demographics
NPI:1083794002
Name:SOWERS, REBECCA JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JO
Last Name:SOWERS
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 1:2900 W PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-9378
Mailing Address - Country:US
Mailing Address - Phone:402-420-9134
Mailing Address - Fax:
Practice Address - Street 1:251 CAPITOL BEACH BLVD
Practice Address - Street 2:SUITE #14
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-1625
Practice Address - Country:US
Practice Address - Phone:402-475-8710
Practice Address - Fax:402-475-8713
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254185-00Medicaid
NE05872OtherBC/BS