Provider Demographics
NPI:1598156572
Name:CLEAN SMILES DENTAL HYGIENE PRACTICE OF CLAIRE FLECKLES AND VICKI HARR
Entity Type:Organization
Organization Name:CLEAN SMILES DENTAL HYGIENE PRACTICE OF CLAIRE FLECKLES AND VICKI HARR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:510-778-8182
Mailing Address - Street 1:229 TEWKSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3829
Mailing Address - Country:US
Mailing Address - Phone:510-778-8182
Mailing Address - Fax:
Practice Address - Street 1:229 TEWKSBURY AVE
Practice Address - Street 2:A
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3829
Practice Address - Country:US
Practice Address - Phone:510-778-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP42124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty