Individual
THERESA MARIE ANSELMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2191 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4534
(805) 781-5503
(805) 781-1235
Mailing address
2191 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4534
(805) 781-5503
(805) 781-1235
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
2788
CO
124Q00000X
Dental Hygienist
Primary
RDH26009
CA
Other
Enumeration date
05/04/2012
Last updated
05/04/2012
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