Healthcare Provider Details

I. General information

NPI: 1215368709
Provider Name (Legal Business Name): HEATHER O'HERN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 32ND ST S
BIRMINGHAM AL
35233-3500
US

IV. Provider business mailing address

716 32ND ST S
BIRMINGHAM AL
35233-3500
US

V. Phone/Fax

Practice location:
  • Phone: 205-326-8060
  • Fax:
Mailing address:
  • Phone: 205-326-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7765
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: