Provider Demographics
NPI:1841437852
Name:TEMP, REBECCA RUNYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RUNYAN
Last Name:TEMP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21724
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-1724
Mailing Address - Country:US
Mailing Address - Phone:928-782-4707
Mailing Address - Fax:928-782-2212
Practice Address - Street 1:2179 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6163
Practice Address - Country:US
Practice Address - Phone:928-782-4707
Practice Address - Fax:928-782-2212
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist