Provider Demographics
NPI:1881110153
Name:LESLIE GIOVANNONI, RDHAP, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LESLIE GIOVANNONI, RDHAP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GIOVANNONI
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:916-765-2251
Mailing Address - Street 1:3958 HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9219
Mailing Address - Country:US
Mailing Address - Phone:916-765-2251
Mailing Address - Fax:916-245-4422
Practice Address - Street 1:3958 HOWARD LN
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-9219
Practice Address - Country:US
Practice Address - Phone:916-765-2251
Practice Address - Fax:916-245-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP560124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty