Provider Demographics
NPI:1013586650
Name:HEDBLOM, CHRISTINE LORRAINE (RDH, MFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LORRAINE
Last Name:HEDBLOM
Suffix:
Gender:F
Credentials:RDH, MFT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LORRAINE
Other - Last Name:HEDBLOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:2600 SHIRE WALK LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6989
Mailing Address - Country:US
Mailing Address - Phone:804-920-1312
Mailing Address - Fax:
Practice Address - Street 1:10446 RIDGEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-3544
Practice Address - Country:US
Practice Address - Phone:804-381-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205234124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0402205234Other0402205234