Provider Demographics
NPI:1366962615
Name:BUIE, REBECCA RUTH (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RUTH
Last Name:BUIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 TRAVIS ST APT 231
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1742
Mailing Address - Country:US
Mailing Address - Phone:1972-816-4126
Mailing Address - Fax:
Practice Address - Street 1:1880 W MOORE AVE STE 7
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2365
Practice Address - Country:US
Practice Address - Phone:972-563-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice