Healthcare Provider Details

I. General information

NPI: 1790874212
Provider Name (Legal Business Name): ARLENE L ERMSHAR BSRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 NORTH BROUD BLVD
GLENDALE CA
91202
US

IV. Provider business mailing address

42 GLENFLOW COURT
GLENDALE CA
91206
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-2253
  • Fax:
Mailing address:
  • Phone: 818-546-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH2535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: