Provider Demographics
NPI:1740067198
Name:BASTINGS, REBECCA D (RDH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:BASTINGS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:D
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7511 GUM RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2185
Mailing Address - Country:US
Mailing Address - Phone:417-388-2296
Mailing Address - Fax:
Practice Address - Street 1:530 S MAIDEN LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3084
Practice Address - Country:US
Practice Address - Phone:417-782-0080
Practice Address - Fax:417-782-0096
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023452124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist