Provider Demographics
NPI:1154556561
Name:DEWOLF FELICES, REBECCA LOUISE (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LOUISE
Last Name:DEWOLF FELICES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 COUNTY HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:763-316-5400
Mailing Address - Fax:763-316-5406
Practice Address - Street 1:2442 COUNTY HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:763-316-5400
Practice Address - Fax:763-780-9005
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855129122300000X
MND12909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist