Healthcare Provider Details

I. General information

NPI: 1528442589
Provider Name (Legal Business Name): HEATHER BLAIR RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 KAYS WAY
CAMBRIDGE VT
05444-4455
US

IV. Provider business mailing address

34 KAYS WAY
CAMBRIDGE VT
05444-4455
US

V. Phone/Fax

Practice location:
  • Phone: 802-316-2242
  • Fax:
Mailing address:
  • Phone: 802-316-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number015.0047046
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: