Provider Demographics
NPI:1780715920
Name:CHAPA, REBEL LEE (RDH)
Entity type:Individual
Prefix:MRS
First Name:REBEL
Middle Name:LEE
Last Name:CHAPA
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 1:401 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6043
Mailing Address - Country:US
Mailing Address - Phone:817-437-9448
Mailing Address - Fax:
Practice Address - Street 1:6050 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2294
Practice Address - Country:US
Practice Address - Phone:972-316-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13963124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist