Provider Demographics
NPI:1952485484
Name:KOEHLER, REBECCA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E INTERSTATE HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-5558
Mailing Address - Country:US
Mailing Address - Phone:956-424-7032
Mailing Address - Fax:956-581-3640
Practice Address - Street 1:213 E INTERSTATE HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-5558
Practice Address - Country:US
Practice Address - Phone:956-424-7032
Practice Address - Fax:956-581-3640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31514122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist