Provider Demographics
NPI:1407671399
Name:VIGER, DEBRA A (RDH, BHS, PHDH, FADH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:VIGER
Suffix:
Gender:F
Credentials:RDH, BHS, PHDH, FADH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8960
Mailing Address - Country:US
Mailing Address - Phone:815-236-9092
Mailing Address - Fax:
Practice Address - Street 1:1395 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8960
Practice Address - Country:US
Practice Address - Phone:815-236-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020-006103124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist