Provider Demographics
NPI:1215398912
Name:PROFFITT, BRITTANY RENAE (RDH)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RENAE
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:RENAE
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:12301 GRAPEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BASTIAN
Mailing Address - State:VA
Mailing Address - Zip Code:24314-4547
Mailing Address - Country:US
Mailing Address - Phone:276-688-2626
Mailing Address - Fax:276-688-4336
Practice Address - Street 1:8487 S SCENIC HIGHWAY
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315
Practice Address - Country:US
Practice Address - Phone:276-688-4711
Practice Address - Fax:276-688-4712
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205919124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist