Individual
BRIENNE R LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3835 FREEPORT BLVD, SACRAMENTO, CA 95822-1318
(707) 337-0726
Mailing address
4848 TUSK WAY, ELK GROVE, CA 95757-1724
(707) 337-0726
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
23969
CA
Other
Enumeration date
07/28/2023
Last updated
07/28/2023
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