Healthcare Provider Details

I. General information

NPI: 1720248503
Provider Name (Legal Business Name): PATTI LOUISE SCOTT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

IV. Provider business mailing address

16365 NORLENE WAY
GRASS VALLEY CA
95949-6612
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-2811
  • Fax:
Mailing address:
  • Phone: 530-559-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number14552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: