Basic Information
Provider Information
NPI: 1306158316
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REHN
FirstName: DARCY
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 16
Address2:  
City: SILVERTHORNE
State: CO
PostalCode: 804980016
CountryCode: US
TelephoneNumber: 9706684054
FaxNumber:  
Practice Location
Address1: 360 PEAK ONE DRIVE
Address2:  
City: FRISCO
State: CO
PostalCode: 80443
CountryCode: US
TelephoneNumber: 9706684040
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/07/2010
LastUpdateDate: 07/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223D0001X10222COY Dental ProvidersDentistDental Public Health

No ID Information.


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