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General NPI Number Information
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NPI Number | 1790429942
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Entity Type | Individual
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Provider Name | ALANA MAHEALANI LIBA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 171 INNER LOOP RD.
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City | FORT IRWIN
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State | CA
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Zip | 92310
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Country | US
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Telephone | 760-380-3173
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Fax |
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Provider Business Mailing Address
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Address Line | 171 INNER LOOP RD. SHUTTLEWORTH DENTAL CLINIC
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City | FOR IRWIN
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State | CA
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Zip | 92310
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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 |
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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 |
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License Number State |
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