Provider Demographics
NPI:1811262108
Name:DENTAL HYGIENE WITH A HEART
Entity type:Organization
Organization Name:DENTAL HYGIENE WITH A HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEES
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:909-744-2752
Mailing Address - Street 1:PO BOX 2323
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-2323
Mailing Address - Country:US
Mailing Address - Phone:909-744-2752
Mailing Address - Fax:
Practice Address - Street 1:1901 NOB HILL DR.
Practice Address - Street 2:
Practice Address - City:RUNNING SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92382-2323
Practice Address - Country:US
Practice Address - Phone:909-744-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP159313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285799742OtherNPI