Provider Demographics
NPI:1851772784
Name:FERNS, REBECCA JEANNE (DDS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEANNE
Last Name:FERNS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEANNE
Other - Last Name:ANGELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4621 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4189
Mailing Address - Country:US
Mailing Address - Phone:785-838-5650
Mailing Address - Fax:
Practice Address - Street 1:4621 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4189
Practice Address - Country:US
Practice Address - Phone:785-838-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611941223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry