Healthcare Provider Details

I. General information

NPI: 1841372661
Provider Name (Legal Business Name): PATRICIA ANNE DELAND RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 442 HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
APO AE NY
09042
US

IV. Provider business mailing address

LILIENWEG 1
BRUEHL BADEN WUERTEMBOURG
68723
DE

V. Phone/Fax

Practice location:
  • Phone: 622-117-2288
  • Fax:
Mailing address:
  • Phone: 06218579450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH5765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: