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General NPI Number Information
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NPI Number | 1104371368
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Entity Type | Organization
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Legal Business Name | MARIE EKINS RDHAP CORP
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 10831 CANELO RD
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City | WHITTIER
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State | CA
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Zip | 90604-1902
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Country | US
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Telephone | 800-280-1608
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Fax | 844-804-2343
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Provider Business Mailing Address
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Address Line | 10831 CANELO RD
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City | WHITTIER
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State | CA
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Zip | 90604-1902
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Country | US
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Telephone | 800-280-1608
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Fax | 844-804-2343
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARIE REBECCA EKINS
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Credential | RDHAP
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Telephone | 800-280-1608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125K00000X
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Taxonomy Name | Advanced Practice Dental Therapist
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License Number | 633
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License Number State | CA
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