Healthcare Provider Details

I. General information

NPI: 1750839056
Provider Name (Legal Business Name): BRENDA UZETA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 N COUNTRY CLUB RD STE A
TUCSON AZ
85716-2831
US

IV. Provider business mailing address

2102 N COUNTRY CLUB RD STE A
TUCSON AZ
85716-2831
US

V. Phone/Fax

Practice location:
  • Phone: 520-408-2288
  • Fax:
Mailing address:
  • Phone: 520-408-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: