Provider Demographics
NPI:1619321353
Name:GURION, EDILYN (RDH)
Entity Type:Individual
Prefix:
First Name:EDILYN
Middle Name:
Last Name:GURION
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 SONOMA BLVD
Mailing Address - Street 2:#A
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3875
Mailing Address - Country:US
Mailing Address - Phone:707-558-2000
Mailing Address - Fax:707-644-3507
Practice Address - Street 1:2920 SONOMA BLVD
Practice Address - Street 2:#A
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3875
Practice Address - Country:US
Practice Address - Phone:707-558-2000
Practice Address - Fax:707-644-3507
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26650124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist