Provider Demographics
NPI:1609957448
Name:ANDERSON, REBECCA GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GAIL
Last Name:ANDERSON
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 1:645 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9363
Mailing Address - Country:US
Mailing Address - Phone:315-685-7162
Mailing Address - Fax:315-685-2055
Practice Address - Street 1:645 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9363
Practice Address - Country:US
Practice Address - Phone:315-685-7162
Practice Address - Fax:315-685-2055
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist