NPI 1053563619

Kellie Renee Bergendahl, RDH

Practitioner Dental Hygienist Plummer, ID

Practice location

Address: 427 12th St, Plummer, ID 83851-4000
Phone: (208) 686-1931
Fax: (208) 686-5133
Mailing address: PO Box 994, Coeur D Alene, ID 83816-0994

Registered specialties

Dental Hygienist Primary

Dental Providers Taxonomy 124Q00000X Licence DH2335 (ID)

Other Dental Hygienist providers in Idaho →

Registry record

NPI: 1053563619
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Oct 2008
Record last updated: 23 Sep 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.