Healthcare Provider Details

I. General information

NPI: 1457453565
Provider Name (Legal Business Name): ERIN M. HROCH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E. NIZHONI BLVD. BOX 1337
GALLUP NM
87301-1337
US

IV. Provider business mailing address

516 E. NIZHONI BLVD. BOX 1337
GALLUP NM
87301-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1565
Mailing address:
  • Phone: 505-722-1000
  • Fax: 505-722-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH1183
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: