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Individual

MARILYNN JEAN HEYDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BS, RDH, MPH

Contact information

Practice address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Mailing address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH 5781
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RDH 5781
STATE LICENSE
CA
Enumeration date
10/14/2010
Last updated
10/14/2010
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