Provider Demographics
NPI:1720840598
Name:LENHARDT, BEVERLY M (RDAEF2 CDA)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:M
Last Name:LENHARDT
Suffix:
Gender:F
Credentials:RDAEF2 CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3515
Mailing Address - Country:US
Mailing Address - Phone:209-482-5007
Mailing Address - Fax:
Practice Address - Street 1:1507 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5182
Practice Address - Country:US
Practice Address - Phone:209-823-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAEF803126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant