Provider Demographics
NPI:1811660798
Name:PRINCE, BRIANNA (RDH)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:837 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1824
Mailing Address - Country:US
Mailing Address - Phone:510-372-7284
Mailing Address - Fax:
Practice Address - Street 1:411 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5716
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32801124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist