Healthcare Provider Details

I. General information

NPI: 1811660798
Provider Name (Legal Business Name): BRIANNA PRINCE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA RAMOS

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 4TH ST STE A
SAN RAFAEL CA
94901-5716
US

IV. Provider business mailing address

837 MOUNTAIN BLVD
OAKLAND CA
94611-1824
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax:
Mailing address:
  • Phone: 510-372-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number32801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: