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NPI Code Detail

MEDICARE: TONYA ELAINE CLARK RDHAP

MEDICARE:   TONYA ELAINE CLARK  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
1124Q00000XDental Hygienist23CA

General Provider Information

NPI Number : 1891777207
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA ELAINE CLARK RDHAP
Provider Business Mailing Address
First Line : 1786 BANNON CREEK DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95833-1518
Country : US
Telephone Number : 916-283-5622
Fax Number : 916-283-5622
Provider Business Practice Location Address
First Line : 1786 BANNON CREEK DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95833-1518
Country : US
Telephone Number : 916-952-5620
Fax Number : 916-283-5622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2005
Last Update Date : 07/08/2007

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Directions to “ TONYA ELAINE CLARK RDHAP” Practice Location

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