Provider Demographics
NPI:1568737369
Name:DENTAL CARE AT HOME DENTAL HYGIENE PRACTICE ERIKA ROSEBAUGH RDHAP,LLC
Entity Type:Organization
Organization Name:DENTAL CARE AT HOME DENTAL HYGIENE PRACTICE ERIKA ROSEBAUGH RDHAP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:707-836-3111
Mailing Address - Street 1:521 CHABLIS DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-6692
Mailing Address - Country:US
Mailing Address - Phone:707-888-8889
Mailing Address - Fax:
Practice Address - Street 1:521 CHABLIS DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6692
Practice Address - Country:US
Practice Address - Phone:707-888-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty