Healthcare Provider Details

I. General information

NPI: 1932480910
Provider Name (Legal Business Name): PATRICIA E. DRENNON RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SYLVAN VISTA DR.
AUBURN CA
95603
US

IV. Provider business mailing address

PO BOX 1304 TRAVELING TOOTH FAIRY
ALTA CA
95701
US

V. Phone/Fax

Practice location:
  • Phone: 916-206-5000
  • Fax:
Mailing address:
  • Phone: 916-206-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP#255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: