Provider Demographics
NPI:1306191622
Name:HOUSTON, KAREN V (RDHAP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:V
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:V
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDHAP
Mailing Address - Street 1:3340 BONITA MESA RD
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1021
Mailing Address - Country:US
Mailing Address - Phone:619-479-6241
Mailing Address - Fax:
Practice Address - Street 1:3340 BONITA MESA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1021
Practice Address - Country:US
Practice Address - Phone:619-479-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist