Provider Demographics
NPI:1750518965
Name:METHERD, REBECCA LYNN (RDH)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:METHERD
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 1:140 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4511
Mailing Address - Country:US
Mailing Address - Phone:970-380-7305
Mailing Address - Fax:303-604-0032
Practice Address - Street 1:3140 VILLAGE VISTA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2527
Practice Address - Country:US
Practice Address - Phone:303-604-0034
Practice Address - Fax:303-604-0032
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905158124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist