Provider Demographics
NPI:1194591222
Name:KERNSMILE DENTAL HYGIENE PRACTICE OF LUISA MORENO RDHAP
Entity type:Organization
Organization Name:KERNSMILE DENTAL HYGIENE PRACTICE OF LUISA MORENO RDHAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:661-859-9946
Mailing Address - Street 1:1402 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1735
Mailing Address - Country:US
Mailing Address - Phone:661-859-9946
Mailing Address - Fax:
Practice Address - Street 1:1402 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1735
Practice Address - Country:US
Practice Address - Phone:661-859-9946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty