Healthcare Provider Details

I. General information

NPI: 1700337268
Provider Name (Legal Business Name): ADRIANNE FLETCHER RDH 30146
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 02/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 E PALMDALE BLVD
PALMDALE CA
93550-4037
US

IV. Provider business mailing address

2151 E PALMDALE BLVD
PALMDALE CA
93550-4037
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-2391
  • Fax:
Mailing address:
  • Phone: 661-942-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number30146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: