MEDICARE: NATASHA DEFENDIS 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	31840	CA
2	174400000X	Specialist	31840	CA

General Provider Information

NPI Number	:	1750997938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA DEFENDIS RDH

Provider Business Mailing Address
First Line	:	3130 ALTA VERDE DR
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-9252
Country	:	US
Telephone Number	:	760-533-3063
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 ALTA VERDE DR
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-9252
Country	:	US
Telephone Number	:	760-533-3063
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	11/01/2021

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