Provider Demographics
NPI:1497804660
Name:RIDEOUT, DOROTHY S (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:S
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:S
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-0752
Mailing Address - Country:US
Mailing Address - Phone:860-228-7878
Mailing Address - Fax:
Practice Address - Street 1:20A LIBERTY DR.
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248
Practice Address - Country:US
Practice Address - Phone:860-228-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004303124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist