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General NPI Number Information
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NPI Number | 1831896844
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Entity Type | Individual
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Provider Name | DANELLE TOMFOHR
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Gender | Female
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 405 KAINS AVE STE 105
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City | ALBANY
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State | CA
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Zip | 94706-1259
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Country | US
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Telephone | 707-740-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 405 KAINS AVE STE 105
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City | ALBANY
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State | CA
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Zip | 94706-1259
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Country | US
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Telephone | 707-740-9210
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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 | RDH15717
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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