Provider Demographics
NPI:1851689244
Name:VAN PAY, REBECCA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:VAN PAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:RECKELBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2352 LINEVILLE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-8863
Mailing Address - Country:US
Mailing Address - Phone:920-471-4988
Mailing Address - Fax:
Practice Address - Street 1:2352 LINEVILLE RD
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8862
Practice Address - Country:US
Practice Address - Phone:920-471-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6679-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist