Provider Demographics
NPI:1053629709
Name:HOMEBOUND DENTAL HYGIENE PRACTICE OF SHONNA LINDO, RDHAP, INC.
Entity Type:Organization
Organization Name:HOMEBOUND DENTAL HYGIENE PRACTICE OF SHONNA LINDO, RDHAP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LINDO
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:949-463-1671
Mailing Address - Street 1:19161 DELAWARE ST
Mailing Address - Street 2:B-01
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2372
Mailing Address - Country:US
Mailing Address - Phone:949-463-1671
Mailing Address - Fax:714-375-0717
Practice Address - Street 1:19161 DELAWARE ST
Practice Address - Street 2:B-01
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2372
Practice Address - Country:US
Practice Address - Phone:949-463-1671
Practice Address - Fax:714-375-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99308OtherDELTA DENTAL OF CALIFORNIA