Healthcare Provider Details

I. General information

NPI: 1720875388
Provider Name (Legal Business Name): KIMBERLY HARTLING WELLES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 DOW DR
EAST HARDWICK VT
05836-9879
US

IV. Provider business mailing address

27 DOW DR
EAST HARDWICK VT
05836-9879
US

V. Phone/Fax

Practice location:
  • Phone: 802-279-2615
  • Fax:
Mailing address:
  • Phone: 802-279-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHART217347
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: