Provider Demographics
NPI:1720362015
Name:OHANA DENTAL HYGIENE PRACTICE
Entity Type:Organization
Organization Name:OHANA DENTAL HYGIENE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:714-638-8709
Mailing Address - Street 1:9877 CHAPMAN AVE
Mailing Address - Street 2:STE. D #413
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841
Mailing Address - Country:US
Mailing Address - Phone:714-638-8709
Mailing Address - Fax:714-638-8917
Practice Address - Street 1:12562 DALE ST UNIT 30
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4565
Practice Address - Country:US
Practice Address - Phone:714-638-8709
Practice Address - Fax:714-638-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP #354124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty