Basic Information
| Provider Information | |||||||||
| NPI: | 1174731673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIZON | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | GARIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4302 CRAB ORCHARD RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ARM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210579752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406878984 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 455 REVOLUTION ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210783330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109393890 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 12/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 13995 | MD | Y | Dental Providers | Dentist | General Practice |
No ID Information.