Rebecca L Van Pay, DDS
Individual provider Active NPI Dentist · Suamico, WI
NPI 1851689244 · NPPES record last updated Feb 7, 2019
Key facts
- NPI
- 1851689244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6679-015 (WI)
- Practice address
- 2352 Lineville Rd
Suamico, WI 54313-8862 - Phone
- (920) 471-4988
- NPI assigned
- Jul 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- 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 |
|---|---|---|---|---|
| I20190108000047 | WI | Order and Referring Only - Dentist |
6103108667 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6679-015 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Univeristy Dental LLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6679-015 | WI | Yes |
Addresses
Primary practice location
2352 Lineville Rd
Suamico, WI 54313-8862
Mailing address
2352 Lineville Rd Ste 112
Suamico, WI 54313-8863
Phone (920) 471-4988
Other practice location 1
1833 University Ave
Green Bay, WI 54302-3637
Phone (920) 437-7444
Other names
- Dr. Rebecca L Reckelberg
Other providers in Suamico, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2019. 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.