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General NPI Number Information
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NPI Number | 1619556602
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Entity Type | Organization
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Legal Business Name | PRISTINE DENTAL HYGIENE PRACTICE OF MICHELLE MILLER RDHAP INC
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 115 E HOBSONWAY
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City | BLYTHE
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State | CA
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Zip | 92225-9222
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Country | US
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Telephone | 760-922-5320
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 411
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City | BLYTHE
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State | CA
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Zip | 92226-0411
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. MICHELLE JEAN MILLER
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Credential | RDHAP
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Telephone | 760-922-5320
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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 |
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License Number State |
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