Individual
INGRID MCLANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5479 E ABBEYFIELD ST, LONG BEACH, CA 90815-3050
(562) 597-1414
Mailing address
4536 ALBURY AVE, LAKEWOOD, CA 90713-2541
(310) 466-3431
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
52645
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N53090
REGISTERED DENTAL ASSISTANT
CA
Enumeration date
01/15/2016
Last updated
01/15/2016
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