Terri Lynn Harbin Ilg, RDH
Individual provider Active NPI Dental Hygienist · Bangor, MI
NPI 1417319476 · NPPES record last updated Mar 28, 2016
Key facts
- NPI
- 1417319476
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 2902005054 (MI)
- Practice address
- 308 Charles Street
Intercare Community Health Network
Bangor, MI 49013 - Phone
- (269) 427-7967
- Fax
- (269) 427-9539
- NPI assigned
- Mar 28, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2902005054 | MI | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902005054 | MI | Yes |
Addresses
Primary practice location
308 Charles Street
Intercare Community Health Network
Bangor, MI 49013
Mailing address
50 Industrial Park Road
Bangor, MI 49013
Phone (269) 427-7937
Other providers in Bangor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.