Provider Demographics
NPI:1194957134
Name:SZYMCZAK EVANS, REBECCA KRISTEN (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KRISTEN
Last Name:SZYMCZAK EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:DUANESBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12056-0327
Mailing Address - Country:US
Mailing Address - Phone:518-895-5288
Mailing Address - Fax:518-895-5290
Practice Address - Street 1:6296 DUANESBURG ROAD
Practice Address - Street 2:
Practice Address - City:DUANESBURG
Practice Address - State:NY
Practice Address - Zip Code:12056
Practice Address - Country:US
Practice Address - Phone:518-895-5288
Practice Address - Fax:518-895-5290
Is Sole Proprietor?:No
Enumeration Date:2009-08-09
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist