1942722384 NPI number — MS. DAGNA SARA BRENDLINGER DENTAL ASSISTANT

Table of content: MS. DAGNA SARA BRENDLINGER DENTAL ASSISTANT (NPI 1942722384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942722384 NPI number — MS. DAGNA SARA BRENDLINGER DENTAL ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENDLINGER
Provider First Name:
DAGNA
Provider Middle Name:
SARA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DENTAL ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942722384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 W CADBURY DR APT J112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-5816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 W CADBURY DR APT J112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095-5816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-242-0902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com