Provider Demographics
NPI:1962757807
Name:PEEBLES, REBECCA KENDALL (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KENDALL
Last Name:PEEBLES
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 1:303 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3914
Mailing Address - Country:US
Mailing Address - Phone:307-742-0722
Mailing Address - Fax:307-742-0727
Practice Address - Street 1:303 S 8TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3914
Practice Address - Country:US
Practice Address - Phone:307-742-0722
Practice Address - Fax:307-742-0727
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15341223G0001X
390200000X
WY15311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program