Provider Demographics
NPI:1508119413
Name:HINDERBERGER, CL (RDH)
Entity Type:Individual
Prefix:
First Name:CL
Middle Name:
Last Name:HINDERBERGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2544
Mailing Address - Country:US
Mailing Address - Phone:928-426-0670
Mailing Address - Fax:928-425-0908
Practice Address - Street 1:198 W OAK ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2544
Practice Address - Country:US
Practice Address - Phone:928-426-0670
Practice Address - Fax:928-425-0908
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH02370124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist