Individual
MS. HOLLY ANN DAVERIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
29 BLACK COAL DRIVE, FORT WASHAKIE DENTAL CLINIC, FORT WASHAKIE, WY 82514-0128
(307) 332-7300
Mailing address
11102 W 4000N RD, BONFIELD, IL 60913-7171
(815) 922-7682
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6127
OR
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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