MEDICARE: HOMEBOUND DENTAL HYGIENE PRACTICE OF SHONNA LINDO, RDHAP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	308	CA

General Provider Information

NPI Number	:	1093012759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEBOUND DENTAL HYGIENE PRACTICE OF SHONNA LINDO, RDHAP, INC.

Provider Business Mailing Address
First Line	:	19161 DELAWARE ST APT B01
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2343
Country	:	US
Telephone Number	:	714-375-0717
Fax Number	:	714-375-0717

Provider Business Practice Location Address
First Line	:	19161 DELAWARE ST APT B01
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2343
Country	:	US
Telephone Number	:	714-375-0717
Fax Number	:	714-375-0717

Authorized Official
Title or Position	:	DENTAL HYGIENIST
Name	:	MS. SHONNA DIZIRI LINDO
Credential	:	RDHAP
Telephone Number	:	949-463-1671

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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