Provider Demographics
NPI:1346031622
Name:VERDUGO, BLANCA DENISE (RDH)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:DENISE
Last Name:VERDUGO
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 1:1914 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2023
Mailing Address - Country:US
Mailing Address - Phone:951-880-5999
Mailing Address - Fax:951-880-5999
Practice Address - Street 1:1585 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8023
Practice Address - Country:US
Practice Address - Phone:909-792-0071
Practice Address - Fax:909-307-8310
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35441124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist