Healthcare Provider Details

I. General information

NPI: 1366723645
Provider Name (Legal Business Name): SUSAN DAVIS RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 WARNER AVE SUITE F370
HUNTINGTON BEACH CA
92647-5495
US

IV. Provider business mailing address

7071 WARNER AVE SUITE F370
HUNTINGTON BEACH CA
92647-5495
US

V. Phone/Fax

Practice location:
  • Phone: 714-907-6874
  • Fax: 888-412-2470
Mailing address:
  • Phone: 714-907-6874
  • Fax: 888-412-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP 366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: