Provider Demographics
NPI:1306482823
Name:ROCHEFORT, KIRSTEN-NIKKI CHRISTINE (EPDH, RDH, BSDH)
Entity type:Individual
Prefix:
First Name:KIRSTEN-NIKKI
Middle Name:CHRISTINE
Last Name:ROCHEFORT
Suffix:
Gender:F
Credentials:EPDH, RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1472
Mailing Address - Country:US
Mailing Address - Phone:503-798-5987
Mailing Address - Fax:
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-9806
Practice Address - Country:US
Practice Address - Phone:503-448-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7821124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist