Healthcare Provider Details

I. General information

NPI: 1467194571
Provider Name (Legal Business Name): CHRISTINA HEKKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BARRETT DR
NIANTIC CT
06357-3527
US

IV. Provider business mailing address

4 BARRETT DR
NIANTIC CT
06357-3527
US

V. Phone/Fax

Practice location:
  • Phone: 720-425-4940
  • Fax:
Mailing address:
  • Phone: 720-425-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2025069
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: