Healthcare Provider Details

I. General information

NPI: 1013272079
Provider Name (Legal Business Name): ANN P. ADAMS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN PITCARN CARMEAN RDH

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 4TH ST
SAN RAFAEL CA
94901-5716
US

IV. Provider business mailing address

411 4TH ST
SAN RAFAEL CA
94901-5716
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-5450
  • Fax: 415-473-5460
Mailing address:
  • Phone: 415-473-5450
  • Fax: 415-473-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: