Provider Demographics
NPI:1982323796
Name:DOTHAGER, REBECCA JANE (RDH/PHDH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:DOTHAGER
Suffix:
Gender:F
Credentials:RDH/PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 IL ROUTE 140
Mailing Address - Street 2:
Mailing Address - City:SMITHBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62284-1023
Mailing Address - Country:US
Mailing Address - Phone:618-410-5483
Mailing Address - Fax:
Practice Address - Street 1:1520 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2618
Practice Address - Country:US
Practice Address - Phone:618-664-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.011562124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist