Individual
KAITLYN APRIL ORNELAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
228 LONDON BRIDGE RD, LAKE HAVASU CITY, AZ 86403-4685
(928) 854-0300
Mailing address
1850 WILLOW AVE, LAKE HAVASU CITY, AZ 86403-5631
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39900047318171
—
AZ
Enumeration date
06/29/2018
Last updated
06/29/2018
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