Provider Demographics
NPI:1245604214
Name:DENTAL HYGIENE PRACTICE OF SHANAY FRY, RDHAP
Entity Type:Organization
Organization Name:DENTAL HYGIENE PRACTICE OF SHANAY FRY, RDHAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANAY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:949-702-6306
Mailing Address - Street 1:13646 ABANA DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1003
Mailing Address - Country:US
Mailing Address - Phone:949-702-6306
Mailing Address - Fax:
Practice Address - Street 1:13646 ABANA DR
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1003
Practice Address - Country:US
Practice Address - Phone:949-702-6306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587251E00000X, 310400000X, 313M00000X, 314000000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities