Provider Demographics
NPI:1720144033
Name:DALE, DARLA DIANE (RDHAP)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:DIANE
Last Name:DALE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MCCLASKEY LN
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6517
Mailing Address - Country:US
Mailing Address - Phone:707-476-0100
Mailing Address - Fax:707-441-1466
Practice Address - Street 1:2101 MCCLASKEY LN
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-6517
Practice Address - Country:US
Practice Address - Phone:707-476-0100
Practice Address - Fax:707-441-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 65124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist