Provider Demographics
NPI:1124385620
Name:DOOLITTLE, REBECCA L
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:124 ASPEN LOOP
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4527
Mailing Address - Country:US
Mailing Address - Phone:612-709-7094
Mailing Address - Fax:
Practice Address - Street 1:124 ASPEN LOOP
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4527
Practice Address - Country:US
Practice Address - Phone:612-709-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13094122300000X
TX29532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist