Provider Demographics
NPI:1942535810
Name:HARSHAW, REBECCA KAY (RDH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:HARSHAW
Suffix:
Gender:F
Credentials:RDH
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 1136
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-1136
Mailing Address - Country:US
Mailing Address - Phone:417-845-2243
Mailing Address - Fax:417-845-2253
Practice Address - Street 1:508 W HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-8548
Practice Address - Country:US
Practice Address - Phone:417-845-2243
Practice Address - Fax:417-845-2253
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003464126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant