=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144835398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROLINDA HARSANY, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2020
-----------------------------------------------------
Last Update Date | 09/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 BEARD RD STE A
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-255-3511
-----------------------------------------------------
Fax | 707-255-9503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 BEARD RD STE A
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-255-3511
-----------------------------------------------------
Fax | 707-255-9503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / DENTIST
-----------------------------------------------------
Name | DR. ROLINDA DEANNE HARSANY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 707-255-3511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------