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General NPI Number Information
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NPI Number | 1104956721
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Entity Type | Individual
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Provider Name | HEATHER LYNN SEYMOUR RDH
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 805 1ST ST
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City | MENOMINEE
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State | MI
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Zip | 49858-3231
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Country | US
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Telephone | 906-863-2315
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Fax |
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Provider Business Mailing Address
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Address Line | 523 CLEVELAND AVE
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City | MARINETTE
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State | WI
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Zip | 54143-3619
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Country | US
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Telephone | 715-732-9229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902014293
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License Number State | MI
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