Provider Demographics
NPI:1396586053
Name:DISARRO, REBECCA ANN (DMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:DISARRO
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:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:ME
Practice Address - Zip Code:04983-3005
Practice Address - Country:US
Practice Address - Phone:207-684-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN5142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist