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General NPI Number Information
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NPI Number | 1780126326
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Entity Type | Organization
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Legal Business Name | RADIANT DENTAL HYGIENE PRACTICE OF LIONA AMIREH-MABANGA
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 19844 VIA OTT
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City | SANTA CLARITA
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State | CA
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Zip | 91321-2192
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Country | US
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Telephone | 818-355-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 19844 VIA OTT
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City | SANTA CLARITA
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State | CA
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Zip | 91321-2192
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Country | US
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Telephone | 818-355-6420
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Fax |
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Authorized Official
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Title or Position | OWNER/RDHAP
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Name | LIONA AMIREH-MABANGA
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Credential |
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Telephone | 818-355-6420
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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 | 621
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License Number State | CA
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