Provider Demographics
NPI:1871879940
Name:MAYBURY, REBECCA RAE (RDH)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RAE
Last Name:MAYBURY
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 1:137 ROSEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9558
Mailing Address - Country:US
Mailing Address - Phone:970-285-7709
Mailing Address - Fax:970-285-7097
Practice Address - Street 1:195 W 14TH
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4700
Practice Address - Country:US
Practice Address - Phone:970-625-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904424124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist