Healthcare Provider Details

I. General information

NPI: 1053629709
Provider Name (Legal Business Name): HOMEBOUND DENTAL HYGIENE PRACTICE OF SHONNA LINDO, RDHAP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19161 DELAWARE ST B-01
HUNTINGTON BEACH CA
92648-2372
US

IV. Provider business mailing address

19161 DELAWARE ST B-01
HUNTINGTON BEACH CA
92648-2372
US

V. Phone/Fax

Practice location:
  • Phone: 949-463-1671
  • Fax: 714-375-0717
Mailing address:
  • Phone: 949-463-1671
  • Fax: 714-375-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number308
License Number StateCA

VIII. Authorized Official

Name: MS. SHONNA D LINDO
Title or Position: DENTAL HYGIENIST
Credential: RDHAP
Phone: 949-463-1671