Provider Demographics
NPI:1508383993
Name:AHEARN, KARLA MARIA (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MARIA
Last Name:AHEARN
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0720
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:30 ELIZABETH STREET
Practice Address - Street 2:SUITE 2, DENTAL DEPARTMENT
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1802
Practice Address - Country:US
Practice Address - Phone:203-736-5460
Practice Address - Fax:203-736-5462
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7105124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist