Individual
MARYANN DETAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3154 ALUM ROCK AVE, SAN JOSE, CA 95127-2903
(669) 232-0311
Mailing address
3154 ALUM ROCK AVE, SAN JOSE, CA 95127-2903
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
26843
CA
Other
Enumeration date
10/29/2020
Last updated
10/29/2020
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