Provider Demographics
NPI:1609574938
Name:REBECCA N. TRIPLETT, PLLC
Entity Type:Organization
Organization Name:REBECCA N. TRIPLETT, PLLC
Other - Org Name:TRIDENT SMILE STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-703-9076
Mailing Address - Street 1:10215 MCINTYRE RIDGE ROAD
Mailing Address - Street 2:STE 104
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134
Mailing Address - Country:US
Mailing Address - Phone:704-703-9076
Mailing Address - Fax:704-833-3270
Practice Address - Street 1:10215 MCINTYRE RIDGE ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134
Practice Address - Country:US
Practice Address - Phone:704-703-9076
Practice Address - Fax:704-833-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10416OtherNORTH CAROLINA STATE DENTAL BOARD