Provider Demographics
NPI:1134472285
Name:PROFESSIONAL DENTAL HYGIENE EXPRESS INC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL HYGIENE EXPRESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:715-933-0065
Mailing Address - Street 1:5388 STATE HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-4788
Mailing Address - Country:US
Mailing Address - Phone:715-933-0065
Mailing Address - Fax:715-568-3545
Practice Address - Street 1:5388 STATE HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-4788
Practice Address - Country:US
Practice Address - Phone:715-933-0065
Practice Address - Fax:715-568-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty