Individual
ELLEN MARY FAWL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
9024 SNIKTAW LN, FORT JONES, CA 96032-9408
(530) 468-4470
(530) 468-5908
Mailing address
9024 SNIKTAW LN, FORT JONES, CA 96032-9408
(530) 468-4470
(530) 468-5908
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH16873
CA
Other
Enumeration date
08/09/2023
Last updated
08/09/2023
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