Provider Demographics
NPI:1578606117
Name:DE GOLIER, REBECCA REYES (DMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:REYES
Last Name:DE GOLIER
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 1:8231 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-3533
Mailing Address - Country:US
Mailing Address - Phone:951-275-2429
Mailing Address - Fax:
Practice Address - Street 1:14495 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4233
Practice Address - Country:US
Practice Address - Phone:760-245-7800
Practice Address - Fax:760-245-6326
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice