Provider Demographics
NPI:1831896844
Name:TOMFOHR, DANELLE
Entity type:Individual
Prefix:
First Name:DANELLE
Middle Name:
Last Name:TOMFOHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KAINS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1259
Mailing Address - Country:US
Mailing Address - Phone:707-740-9210
Mailing Address - Fax:
Practice Address - Street 1:405 KAINS AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1259
Practice Address - Country:US
Practice Address - Phone:707-740-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH15717124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No124Q00000XDental ProvidersDental Hygienist