Provider Demographics
NPI:1497007108
Name:MAINO, REBECCA ANN (RDH, BS)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:MAINO
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 U.S. HIGHWAY 41 EAST
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9671
Mailing Address - Country:US
Mailing Address - Phone:906-315-2602
Mailing Address - Fax:909-475-4435
Practice Address - Street 1:184 U.S. HIGHWAY 41 EAST
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-9671
Practice Address - Country:US
Practice Address - Phone:906-315-2602
Practice Address - Fax:909-475-4435
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902008058124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist