Provider Demographics
NPI:1366183337
Name:REIFERT, REBECCA LEE (RDH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:REIFERT
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 1:6548 GALBRAITH LINE RD
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-9123
Mailing Address - Country:US
Mailing Address - Phone:810-712-7175
Mailing Address - Fax:
Practice Address - Street 1:3037 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6615
Practice Address - Country:US
Practice Address - Phone:810-984-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902011825124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist