Healthcare Provider Details

I. General information

NPI: 1780126326
Provider Name (Legal Business Name): RADIANT DENTAL HYGIENE PRACTICE OF LIONA AMIREH-MABANGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19844 VIA OTT
SANTA CLARITA CA
91321-2192
US

IV. Provider business mailing address

19844 VIA OTT
SANTA CLARITA CA
91321-2192
US

V. Phone/Fax

Practice location:
  • Phone: 818-355-6420
  • Fax:
Mailing address:
  • Phone: 818-355-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number621
License Number StateCA

VIII. Authorized Official

Name: LIONA AMIREH-MABANGA
Title or Position: OWNER/RDHAP
Credential:
Phone: 818-355-6420