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General NPI Number Information
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NPI Number | 1437221868
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Entity Type | Individual
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Provider Name | HEATHER REBECCA BOTNEN R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BLDG N46 US COAST GUARD BASE
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City | KODIAK
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State | AK
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Zip | 99615
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Country | US
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Telephone | 907-487-5757
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Fax | 907-487-5360
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Provider Business Mailing Address
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Address Line | 200 ALBATROSS AVE APT A
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City | KODIAK
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State | AK
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Zip | 99615-6810
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Country | US
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Telephone | 907-487-2309
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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 | 1010
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 579
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H4372
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00005124
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License Number State | WA
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