Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DEN-RDH-LIC-1311 | MT |
NPI | 1003280223 |
---|---|
Provider Name | Diedri Durocher |
First Address | Great Falls, MT 59404-6319 |
Second Address | Great Falls, MT 59404-6319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2015 |
Last Update Date | 27/11/2015 |