Provider Demographics
NPI:1588890347
Name:NEITZKE, REBECCA SUE (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE
Last Name:NEITZKE
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 1:8200 E BELLEVIEW AVE STE 426C
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2851
Mailing Address - Country:US
Mailing Address - Phone:720-649-0430
Mailing Address - Fax:
Practice Address - Street 1:8200 E BELLEVIEW AVE STE 426C
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2851
Practice Address - Country:US
Practice Address - Phone:720-649-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12680122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist