MEDICARE: MISS MARIANNE WHITFIELD RDH

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	RDH18824	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RDH18824	OTHER	CA	RDH LICENSE

General Provider Information

NPI Number	:	1730272394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIANNE WHITFIELD RDH

Provider Business Mailing Address
First Line	:	1203 CAMINO CORTO
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-3590
Country	:	US
Telephone Number	:	707-765-7234
Fax Number	:	707-765-7521

Provider Business Practice Location Address
First Line	:	599 TOMALES RD
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5002
Country	:	US
Telephone Number	:	707-765-7234
Fax Number	:	707-765-7521

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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