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SHELLY MARIE AZEVEDO RDH
>> Dental Hygienist >> Dental ProvidersRegistrant NPI Number: 1174021661
Individual Registrant: SHELLY MARIE AZEVEDO RDH
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
311 W OAK ST LODI, CA 95240-3401 US
Tel: 209-327-2446 Fax: --
Tel: 209-327-2446 Fax: --
Contact information for business:
311 W OAK ST LODI, CA 95240-3401 US
Tel: 209-327-2446 Fax: --
Tel: 209-327-2446 Fax: --
Registration Information:
NPI: 1174021661
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 124Q00000X | Dental Providers Dental Hygienist | CA | 11388 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
