Provider Demographics
NPI:1154559490
Name:WACHTEL, REBECCA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:WACHTEL
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 1:16918 DOVE CANYON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3445
Mailing Address - Country:US
Mailing Address - Phone:858-924-1000
Mailing Address - Fax:858-244-7911
Practice Address - Street 1:16918 DOVE CANYON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3445
Practice Address - Country:US
Practice Address - Phone:858-924-1000
Practice Address - Fax:858-244-7911
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412749122300000X
CA64199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist