Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 905597 | CO |
NPI | 1063965788 |
---|---|
Provider Name | Kari Hettinger |
First Address | Ault, CO 80610-9605 |
Second Address | Ault, CO 80610-9605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |