Provider Demographics
NPI:1518374271
Name:KOON, REBEKAH ANNE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:ANNE
Last Name:KOON
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-0511
Mailing Address - Country:US
Mailing Address - Phone:615-847-3088
Mailing Address - Fax:615-847-8479
Practice Address - Street 1:102 22ND ST
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-2502
Practice Address - Country:US
Practice Address - Phone:615-847-3088
Practice Address - Fax:615-847-8479
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist