Provider Demographics
NPI:1215581632
Name:KING, REBECCA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUSAN
Last Name:KING
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 1:1435 POINSETT DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9233
Mailing Address - Country:US
Mailing Address - Phone:919-210-2479
Mailing Address - Fax:919-929-4545
Practice Address - Street 1:120 CONNER DR STE 201
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7092
Practice Address - Country:US
Practice Address - Phone:919-960-0155
Practice Address - Fax:919-960-0551
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist