Provider Demographics
NPI:1821105941
Name:HETHERINGTON, DONNA RENEE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:RENEE
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:RENEE
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:USA, RWBAHC DENTAC
Mailing Address - Street 2:2240 E. WINROW AVE
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613
Mailing Address - Country:US
Mailing Address - Phone:520-533-3144
Mailing Address - Fax:
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:WUEZBURG DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:931-804-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 17371124Q00000X
FLDH17371124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist