Healthcare Provider Details

I. General information

NPI: 1255252151
Provider Name (Legal Business Name): ROOTED SMILES DENTAL HYGIENE PRACTICE OF KRISTIAN LERMA RDHAP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 BUENA VISTA RD
HOLLISTER CA
95023-3264
US

IV. Provider business mailing address

1581 BUENA VISTA RD
HOLLISTER CA
95023-3264
US

V. Phone/Fax

Practice location:
  • Phone: 831-524-7009
  • Fax:
Mailing address:
  • Phone: 831-524-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIAN LERMA
Title or Position: CEO
Credential: RDHAP
Phone: 831-524-7009