Individual
HEATHER REBECCA BOTNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
BLDG N46 US COAST GUARD BASE, KODIAK, AK 99615
(907) 487-5757
(907) 487-5360
Mailing address
200 ALBATROSS AVE APT A, KODIAK, AK 99615-6810
(907) 487-2309
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1010
AK
124Q00000X
Dental Hygienist
579
AK
124Q00000X
Dental Hygienist
DH00005124
WA
124Q00000X
Dental Hygienist
H4372
OR
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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