Individual
VANGE IRENE LEONIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDHAP
Contact information
Practice address
856 CYPRESS AVE, NOVATO, CA 94947-3925
(415) 898-7390
(415) 898-7389
Mailing address
926A DIABLO AVE # 122, NOVATO, CA 94947-4025
(415) 898-7390
(415) 898-7389
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H00047
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147054
DELTA DENTAL OF CA.
CA
05
—
H00047-01
—
CA
Enumeration date
12/26/2006
Last updated
07/08/2007
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