Provider Demographics
NPI:1811681042
Name:DIVINE DENTAL HYGIENE PRACTICE OF AMANDA SOLIS, RDHAP
Entity type:Organization
Organization Name:DIVINE DENTAL HYGIENE PRACTICE OF AMANDA SOLIS, RDHAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-399-0103
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-1132
Mailing Address - Country:US
Mailing Address - Phone:530-399-0103
Mailing Address - Fax:
Practice Address - Street 1:9412 MIDWAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CA
Practice Address - Zip Code:95938-9535
Practice Address - Country:US
Practice Address - Phone:530-399-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty