Healthcare Provider Details

I. General information

NPI: 1538873716
Provider Name (Legal Business Name): CORRYN VIGUE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

IV. Provider business mailing address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-3770
  • Fax: 860-523-6411
Mailing address:
  • Phone: 860-523-3770
  • Fax: 860-523-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number007437
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: