Provider Demographics
NPI:1477728822
Name:NG, CONNIE LORI (RDH, RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LORI
Last Name:NG
Suffix:
Gender:F
Credentials:RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226A WESTBOROUGH BLVD # 148
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5405
Mailing Address - Country:US
Mailing Address - Phone:415-867-4815
Mailing Address - Fax:650-871-7848
Practice Address - Street 1:2226A WESTBOROUGH BLVD # 148
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5405
Practice Address - Country:US
Practice Address - Phone:415-867-4815
Practice Address - Fax:650-871-7848
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 126124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist