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General NPI Number Information
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NPI Number | 1336346006
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Entity Type | Individual
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Provider Name | MARY ANAGENE FANCHER RDH
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 350 COURT ST
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City | HUNTSVILLE
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State | TN
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Zip | 37756
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Country | US
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Telephone | 423-663-8200
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Fax | 423-663-8544
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Provider Business Mailing Address
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Address Line | PO BOX 5164
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City | ONEIDA
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State | TN
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Zip | 37841-5164
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Country | US
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Telephone | 423-663-3730
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Fax | 423-663-8544
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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 | DH0000004284
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License Number State | TN
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