Provider Demographics
NPI:1649232844
Name:TATE, REBECCA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE
Last Name:TATE
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 3000
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-3000
Mailing Address - Country:US
Mailing Address - Phone:919-575-1160
Mailing Address - Fax:919-575-1167
Practice Address - Street 1:160 SOLTERRA WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-7314
Practice Address - Country:US
Practice Address - Phone:919-402-8660
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998258Medicaid