=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205570876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AYANNA BRINEA POWELL RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2022
-----------------------------------------------------
Last Update Date | 06/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3709 MASONIC DR
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-269-6422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4351 GARDEN CITY DR
-----------------------------------------------------
City | LANDOVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-615-3052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 5352
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 8398
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------