Provider Demographics
NPI:1740057447
Name:WOOLAM, REBECCA NICOLE (DH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:NICOLE
Last Name:WOOLAM
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 LOST CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8771
Mailing Address - Country:US
Mailing Address - Phone:907-500-2418
Mailing Address - Fax:
Practice Address - Street 1:4575 BYRD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7198
Practice Address - Country:US
Practice Address - Phone:970-593-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002026784124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist