Healthcare Provider Details

I. General information

NPI: 1902273196
Provider Name (Legal Business Name): DENTAL HYGIENE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26692 BRIDLEWOOD DR
LAGUNA HILLS CA
92653-7570
US

IV. Provider business mailing address

26692 BRIDLEWOOD DR
LAGUNA HILLS CA
92653-7570
US

V. Phone/Fax

Practice location:
  • Phone: 949-328-7895
  • Fax:
Mailing address:
  • Phone: 949-328-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number564
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number564
License Number StateCA

VIII. Authorized Official

Name: MRS. EDITH RECHEL ROSALES
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDHAP
Phone: 949-328-7895