Provider Demographics
NPI:1003280223
Name:DUROCHER, DIEDRI (RDH, BS)
Entity Type:Individual
Prefix:
First Name:DIEDRI
Middle Name:
Last Name:DUROCHER
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SUN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6319
Mailing Address - Country:US
Mailing Address - Phone:406-781-4473
Mailing Address - Fax:
Practice Address - Street 1:78 SUN RIVER RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-6319
Practice Address - Country:US
Practice Address - Phone:406-781-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-RDH-LIC-1311124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist