Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 006246 | CT |
NPI | 1023006145 |
---|---|
Provider Name | Heather Slocombe |
First Address | Middletown, CT 06457-2718 |
Second Address | Old Saybrook, CT 06475-2326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |