Provider Demographics
NPI:1225689003
Name:REBAR, KRISTA MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:REBAR
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 1:505 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1323
Mailing Address - Country:US
Mailing Address - Phone:570-489-5663
Mailing Address - Fax:570-489-5688
Practice Address - Street 1:505 SUNSET DR
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1323
Practice Address - Country:US
Practice Address - Phone:570-489-5663
Practice Address - Fax:570-489-5688
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0424661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice