Individual
IVY BURGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
2798 YULUPA AVE STE 3, SANTA ROSA, CA 95405-8570
(707) 542-7299
Mailing address
5220 FULTON RD APT 6, SANTA ROSA, CA 95403-1242
(707) 889-4306
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA92988
CA
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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