Provider Demographics
NPI:1043376445
Name:MINTZ-GECOVICH, REBECCA (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:MINTZ-GECOVICH
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 1:6789 RIDGE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5649
Mailing Address - Country:US
Mailing Address - Phone:440-845-6420
Mailing Address - Fax:440-845-6427
Practice Address - Street 1:6789 RIDGE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5649
Practice Address - Country:US
Practice Address - Phone:440-845-6420
Practice Address - Fax:440-845-6427
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist