Healthcare Provider Details

I. General information

NPI: 1992207807
Provider Name (Legal Business Name): AIMEE BESTUL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N8077 COUNTY RD E
OGDENSBURG WI
54962-9730
US

IV. Provider business mailing address

N8077 COUNTY RD E
OGDENSBURG WI
54962-9730
US

V. Phone/Fax

Practice location:
  • Phone: 715-412-3320
  • Fax:
Mailing address:
  • Phone: 715-412-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6709-016
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: