Rebecca Gail Anderson, D.D.S.
Individual provider Active NPI Dentist · Skaneateles, NY
NPI 1609957448 · NPPES record last updated Jan 5, 2012
Key facts
- NPI
- 1609957448
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 050563 (NY)
- Practice address
- 645 W Genesee Street Rd
Skaneateles, NY 13152-9363 - Phone
- (315) 685-7162
- Fax
- (315) 685-2055
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160406000658 | NY | Order and Referring Only - Dentist |
0941508089 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 050563 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skaneateles Dental Associates, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 050563 | NY | Yes |
Addresses
Primary practice location
645 W Genesee Street Rd
Skaneateles, NY 13152-9363
Mailing address
645 W Genesee Street Rd
Skaneateles, NY 13152-9363
Phone (315) 685-7162
Other providers in Skaneateles, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.