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General NPI Number Information
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NPI Number | 1407262389
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Entity Type | Individual
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Provider Name | JANET LAVON BURGESS RDHAP, BS
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Gender | Female
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 1560 PEPPER DR
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City | EL CENTRO
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State | CA
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Zip | 92243-4124
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Country | US
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Telephone | 760-332-9253
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Fax |
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Provider Business Mailing Address
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Address Line | 2328 BOUGAINVILLEA TRL
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City | IMPERIAL
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State | CA
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Zip | 92251-8965
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Country | US
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Telephone | 760-332-9253
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Fax | 760-370-9235
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HAP 494
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License Number State | CA
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