Provider Demographics
NPI:1982607891
Name:BREVARD, REBEKAH R (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:R
Last Name:BREVARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0898
Mailing Address - Country:US
Mailing Address - Phone:609-465-4340
Mailing Address - Fax:609-465-5064
Practice Address - Street 1:101 STONE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2135
Practice Address - Country:US
Practice Address - Phone:609-465-3111
Practice Address - Fax:609-465-5064
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0221211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery