KELLIE RENEE BERGENDAHL (NPI# 1053563619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053563619 |
| Entity Type | Individual |
| Full Name | KELLIE RENEE BERGENDAHL |
| Other Name | MS. KELLIE R. MCNEIL |
| Credential | RDH |
| Practice Address |
427 12th St Plummer ID 83851-4000 |
| Mailing Address |
Po Box 994 Coeur D Alene ID 83816-0994 |
| Practice Telephone | 2086861931 |
| Practice Fax Number | 2086865133 |
| Mailing Telephone | 2086250353 |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2019-09-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | DH2335 | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | STATE LICENSE | RDH 20164 | 01 |
| Street Address |
427 12TH ST |
| City | PLUMMER |
| State | ID |
| Zip Code | 83851-4000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225697212 | Tonya Marie Amour-patton | Counselor | 427 12th St, Plummer, ID 83851-4000 | 2019-06-12 |
| 1043873995 | John Bronsell Ryan Bronsell | Pharmacist | 427 12th St, Plummer, ID 83851-4000 | 2019-04-16 |
| 1023572963 | Michelle Kay Moore | Counselor | 427 12th St, Plummer, ID 83851-4000 | 2019-01-24 |
| 1710499504 | Sara Holland | Pharmacist | 427 12th St, Plummer, ID 83851-4000 | 2017-11-02 |
| 1902268238 | Andrew Ellis Gardner | Internal Medicine | 427 12th St, Plummer, ID 83851-4000 | 2016-03-25 |
| 1013237189 | Jamie Dee Smith | Counselor | 427 12th St, Plummer, ID 83851-4000 | 2010-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326575325 | Terrin Loe | Dental Hygienist | 358-786 Long Road, Plummer, ID 83851 | 2017-05-22 |
| 1639542830 | Selene Bonnell-hall | Physical Therapy Assistant | 1100 A Street, Plummer, ID 83851 | 2015-11-10 |
| 1609245059 | Caley Jordan | Pharmacist | 427 N 12 St, Plummer, ID 83851 | 2015-09-16 |
| 1861741282 | Plummer Gateway Fire Protection | Ambulance | 609 Poleyard Rd, Plummer, ID 83851 | 2012-08-30 |
| 1497040349 | Jason Ford Chapman | General Practice | 427 N. 12th St., Plummer, ID 83851 | 2011-06-17 |
| 1861797060 | Tiffany Marie Korrer | Physical Therapy Assistant | 1100 A. Street, Plummer, ID 83851 | 2011-01-19 |
| 1710290234 | Brian Meyer | Optometrist | 427 Nth 12th St, Plummer, ID 83851 | 2010-07-26 |
| 1386884369 | James Smith | Clinical Medical Laboratory | 1115 E. St, Plummer, ID 83851 | 2009-03-03 |
| 1134378169 | Robert Samuel Davis | Physician Assistant | 427 N 12th St., Plummer, ID 83851 | 2008-09-15 |
| 1013192210 | Nikole J Mills | Nurse Practitioner | 427 N. 12th Street, Plummer, ID 83851 | 2008-01-07 |
| Find all providers in zip 83851 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326575325 | Terrin Loe | Dental Hygienist | 358-786 Long Road, Plummer, ID 83851 | 2017-05-22 |
| 1225244551 | Kimberley Dawn Legaspi | Dental Hygienist | 1115 B Street, Plummer, ID 83851-0388 | 2007-05-15 |
| 1447231303 | Cathleen L Laplante | Dental Hygienist | 1115 B St, Plummer, ID 83851-0388 | 2005-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649898578 | Michelle Ann Watkins | Dental Hygienist | 721 Northstar Dr, Hailey, ID 83333-8501 | 2020-07-07 |
| 1124644364 | Teena Barnes | Dental Hygienist | 3915 E 154 N, Rigby, ID 83442-5727 | 2020-06-23 |
| 1467966499 | Melanie Hill | Dental Hygienist | 550 W Sunnyside Rd Ste 7, Idaho Falls, ID 83402-4642 | 2017-11-29 |
| 1427589936 | Jamie Rowe | Dental Hygienist | 581 N Whitewater Park Blvd Apt D202, Boise, ID 83702-5689 | 2017-03-26 |
| 1104207216 | Caring Smiles Pllc | Dental Hygienist | 8744 W. Fairview Ave, Boise, ID 83704 | 2015-06-15 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1790916476 | Thressa K. Fogleman | Dental Hygienist | 2355 American Legion Blvd, Mountain Home, ID 83647-3145 | 2009-07-29 |
| 1972720936 | Idaho State University | Dental Hygienist | 999 Martin Luther King Jr. Way, Pocatello, ID 83209-8048 | 2007-04-19 |
| 1093761694 | Family Health Services Corporation | Dental Hygienist | 402 6th St, Rupert, ID 83350 | 2006-05-25 |
| 1518581370 | Chelsea Ann Hansen | Dental Hygienist | 1067 S Wells St, Meridian, ID 83642-7997 | 2020-06-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.