MEDICARE: INGRI SEATH SPARLING RDHAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	209	CA

General Provider Information

NPI Number	:	1417135286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRI SEATH SPARLING RDHAP

Provider Business Mailing Address
First Line	:	4638 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-5311
Country	:	US
Telephone Number	:	707-843-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4638 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-5311
Country	:	US
Telephone Number	:	707-843-3896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	03/05/2010

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