Healthcare Provider Details

I. General information

NPI: 1326338187
Provider Name (Legal Business Name): MARSHA STORME CENTER RDH, RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16654 SOLEDAD CANYON RD #202
CANYON COUNTRY CA
91387-3217
US

IV. Provider business mailing address

16654 SOLEDAD CANYON RD #202
CANYON COUNTRY CA
91387-3217
US

V. Phone/Fax

Practice location:
  • Phone: 661-298-4720
  • Fax: 661-298-4720
Mailing address:
  • Phone: 661-298-4720
  • Fax: 661-298-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: