Provider Demographics
NPI:1407854102
Name:FACY, REBECCA A (MD,DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:FACY
Suffix:
Gender:F
Credentials:MD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 CHAPEL HILLS DR
Mailing Address - Street 2:#300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1022
Mailing Address - Country:US
Mailing Address - Phone:719-599-0500
Mailing Address - Fax:719-599-0575
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:#300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1022
Practice Address - Country:US
Practice Address - Phone:719-599-0500
Practice Address - Fax:719-599-0575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8955OtherSTATE LICENSE