Individual
MRS. KELLY LORAINE HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
883 W MARCH LN, STOCKTON, CA 95207
(209) 636-5555
Mailing address
828 N D ST, STOCKTON, CA 95205-4323
(510) 586-4960
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
34146
CA
Other
Enumeration date
12/16/2021
Last updated
12/20/2021
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