Healthcare Provider Details

I. General information

NPI: 1417779281
Provider Name (Legal Business Name): SANDY MARIE YETMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SMITH RD BLDG 23
NEWPORT RI
02841-1006
US

IV. Provider business mailing address

344 MOHAWK DR
WESTPORT MA
02790-1811
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-2542
  • Fax:
Mailing address:
  • Phone: 508-320-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH87088
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: