Provider Demographics
NPI:1447443916
Name:REBREY, JERRY
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:REBREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MAHALEY AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2631
Mailing Address - Country:US
Mailing Address - Phone:704-637-0609
Mailing Address - Fax:
Practice Address - Street 1:1710 WALKER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2549
Practice Address - Country:US
Practice Address - Phone:704-633-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice