Provider Demographics
NPI:1043439623
Name:ALTERNATIVE DENTAL HYGIENE OF CALIFORNIA
Entity type:Organization
Organization Name:ALTERNATIVE DENTAL HYGIENE OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PRIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-663-8345
Mailing Address - Street 1:8806 ROCKHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4252
Mailing Address - Country:US
Mailing Address - Phone:661-834-2810
Mailing Address - Fax:
Practice Address - Street 1:8806 ROCKHAMPTON DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4252
Practice Address - Country:US
Practice Address - Phone:661-834-2810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA147058OtherDELTA DENTAL
CAZ98419-1OtherHEALTHY FAMILIES