Provider Demographics
NPI:1518105873
Name:ANDERSON, REBECCA ANN (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8187
Mailing Address - Country:US
Mailing Address - Phone:805-390-8899
Mailing Address - Fax:
Practice Address - Street 1:933 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8187
Practice Address - Country:US
Practice Address - Phone:805-390-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP222124Q00000X
CA19758124Q00000X
MT1368124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist