Healthcare Provider Details

I. General information

NPI: 1205603826
Provider Name (Legal Business Name): DENTAL HYGIENE PRACTICE OF PAULA GRIECO RDHAP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1758 N BUNDY AVE
CLOVIS CA
93619-8151
US

IV. Provider business mailing address

1758 N BUNDY AVE
CLOVIS CA
93619-8151
US

V. Phone/Fax

Practice location:
  • Phone: 559-395-1991
  • Fax:
Mailing address:
  • Phone: 559-395-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAULA GRIECO
Title or Position: DENTAL HYGIENIST IN ALTERNATIVE PRA
Credential: RDHAP
Phone: 559-395-1991