Provider Demographics
NPI:1215662879
Name:REBMAN, MARY (RDH, PHDH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:REBMAN
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62319-4008
Mailing Address - Country:US
Mailing Address - Phone:217-248-7782
Mailing Address - Fax:
Practice Address - Street 1:330 VERMONT ST STE 100
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2700
Practice Address - Country:US
Practice Address - Phone:217-222-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020012128124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist