Provider Demographics
NPI:1558776906
Name:LLUSD DENTAL HYGIENE PROGRAM & CLINIC
Entity Type:Organization
Organization Name:LLUSD DENTAL HYGIENE PROGRAM & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-558-4543
Mailing Address - Street 1:11092 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1706
Mailing Address - Country:US
Mailing Address - Phone:909-558-4613
Mailing Address - Fax:909-558-4192
Practice Address - Street 1:34280 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0857
Practice Address - Country:US
Practice Address - Phone:760-324-2091
Practice Address - Fax:760-324-9509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOMA LINDA UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7547124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty