Provider Demographics
NPI:1992161947
Name:DOWNING, VIRGINIA STOUT (RDH, OMT)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:STOUT
Last Name:DOWNING
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 REDWOOD ROAD
Mailing Address - Street 2:#19
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619
Mailing Address - Country:US
Mailing Address - Phone:510-479-3591
Mailing Address - Fax:
Practice Address - Street 1:5707 REDWOOD ROAD
Practice Address - Street 2:#19
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619
Practice Address - Country:US
Practice Address - Phone:510-479-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4486124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist