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General NPI Number Information
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NPI Number | 1881461952
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Entity Type | Organization
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Legal Business Name | FLOSSOPHY THE DENTAL HYGIENE PRACTICE OF JENNIFER DE'LAVIGNE, INC.
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 203 E PINE ST
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City | FORT BRAGG
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State | CA
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Zip | 95437-3306
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Country | US
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Telephone | 707-962-8044
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Fax |
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Provider Business Mailing Address
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Address Line | 203 E PINE ST
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City | FORT BRAGG
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State | CA
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Zip | 95437-3306
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Country | US
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Telephone | 707-962-8044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER CHRISTY DE'LAVIGNE
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Credential | RDHAP
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Telephone | 707-357-5246
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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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