Provider Demographics
NPI:1730161167
Name:NUNLEY, REBECCA LOU (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LOU
Last Name:NUNLEY
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 1:300 W WATAUGA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5549
Mailing Address - Country:US
Mailing Address - Phone:423-979-1800
Mailing Address - Fax:423-979-1802
Practice Address - Street 1:300 W WATAUGA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5549
Practice Address - Country:US
Practice Address - Phone:423-979-1800
Practice Address - Fax:423-979-1802
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS45151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice