Organization
CABRILLO COLLEGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIDGETE H CLARK (PROGRAM CHAIR)
(831) 479-6431
Entity
Organization
Contact information
Practice address
6500 SOQUEL DR, APTOS, CA 95003-3119
(831) 479-6431
Mailing address
6500 SOQUEL DR, APTOS, CA 95003-3119
(831) 479-6431
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
22173
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22173
DENTIST
CA
Enumeration date
06/18/2007
Last updated
08/22/2020
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