Provider Demographics
NPI:1831537331
Name:LEONARD, REBECCA JEAN (RDH)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JEAN
Last Name:LEONARD
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 1:816 S MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3305
Mailing Address - Country:US
Mailing Address - Phone:971-275-5095
Mailing Address - Fax:
Practice Address - Street 1:7965 SW MOHAWK ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9193
Practice Address - Country:US
Practice Address - Phone:971-275-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6367124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist