Healthcare Provider Details

I. General information

NPI: 1811069024
Provider Name (Legal Business Name): TERESE (TERRI) ANN HOEF RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESE (TERRI) ANN KLARICH RDH

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LOSEY ST
SCOTT AIR FORCE BASE IL
62225-5250
US

IV. Provider business mailing address

962 LONG BRANCH RD
TROY IL
62294-3137
US

V. Phone/Fax

Practice location:
  • Phone: 618-256-2123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902005439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: