Provider Demographics
NPI:1104095082
Name:CABLE, THERESA ANN (RDHAP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:CABLE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:ANN
Other - Last Name:CABLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDHAP
Mailing Address - Street 1:PO BOX 954
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-0954
Mailing Address - Country:US
Mailing Address - Phone:925-890-7428
Mailing Address - Fax:
Practice Address - Street 1:105 SAINT EDWARD CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5241
Practice Address - Country:US
Practice Address - Phone:925-890-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist