MRS. MARILYN BLACKMUN (NPI# 1790909349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1790909349 |
Entity Type | Individual |
Full Name | MRS. MARILYN BLACKMUN |
Credential | PDHAP |
Practice Address |
2209 San Gorgonio Rd La Canada CA 91011-1352 |
Practice Telephone | 8189571589 |
Practice Fax Number | 8189571589 |
Mailing Telephone | 8189571589 |
Mailing Fax Number | 8189571589 |
Enumeration Date | 2007-04-13 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP11 | CA | Dental Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | 28993701 | 05 | |
CA | DELTA DENTAL INS | 133068 | 01 |
Street Address |
2209 SAN GORGONIO RD |
City | LA CANADA |
State | CA |
Zip Code | 91011-1352 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720528466 | Gina Lynn Horton | Acupuncturist | 890-b Town Center Drive, La Canada, CA 91011 | 2017-02-28 |
1215381777 | Richard Alan Compton | Family Medicine | 1109 Foothill Blvd, La Canada, CA 91011 | 2016-04-20 |
1073865390 | Drs. Ho Dental Partnership | Dentist | 400 Foothill Blvd., La Canada, CA 91011 | 2012-10-10 |
1477803369 | Amanda Ghattas | Student in an Organized Health Care Education/Training Program | 1323 Verdugo Blvd, La Canada Flintridge, CA 91011 | 2012-09-18 |
1992053441 | Ronald Leonard Polito | Internal Medicine | 4381 Shepherds Lane, La Canada, CA 91011 | 2012-08-15 |
1699089508 | Talha Khawar | Internal Medicine | 1975 Verdugo Blvd, La Canada, CA 91011 | 2010-08-03 |
1396999728 | Lester Baker Jr. | Family Medicine | 4404 Chevy Chase Dr., La Canada, CA 91011 | 2008-11-12 |
1306098280 | Vicky W Ling | Pharmacist | 523 Foothill Blvd., La Canada, CA 91011 | 2008-10-22 |
1770799850 | Gary Lynn Coleman | Marriage & Family Therapist | 1313 Foothill Bl., Suite 9, La Canada, CA 91011 | 2007-05-15 |
1881815884 | Sharon Elaine Milan | Marriage & Family Therapist | 1313 Foothill Boulevard, Suite 3, La Canada Flintridge, CA 91011 | 2007-05-01 |
Find all providers in zip 91011 |
Taxonomy Code | 124Q00000X |
Grouping | Dental Providers |
Classification | Dental Hygienist |
An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588960223 | Linda Sbicca Rowland | Dental Hygienist | 1102 Lavender Ln, La Canada, CA 91011-2339 | 2011-01-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346841046 | Betty Satomi Fukumoto | Dental Hygienist | 16008 S Manhattan Pl, Gardena, CA 90247-3681 | 2020-11-08 |
1417558180 | Maria Antonette De Lara Kim | Dental Hygienist | 66 S San Gorgonio Ave Ste 5, Banning, CA 92220-6020 | 2020-11-07 |
1083215982 | Sokbunntha Yan | Dental Hygienist | 5810 Fidler Ave, Lakewood, CA 90712-1251 | 2020-11-06 |
1649871914 | Maryam Ghahramani Shahneshin | Dental Hygienist | 1961 Grove Pl, Escondido, CA 92027-4101 | 2020-11-04 |
1285234047 | Maryann Detar | Dental Hygienist | 3154 Alum Rock Ave, San Jose, CA 95127-2903 | 2020-10-29 |
1194325597 | Connie Lim Good | Dental Hygienist | 14th Street Bldg 13128, Oceanside, CA 92055 | 2020-10-27 |
1336748896 | Cynthia Garcia Macdougall | Dental Hygienist | 444 Hermosa Ave Apt 302, Hermosa Beach, CA 90254-4433 | 2020-10-25 |
1346849163 | Ambrosia Evon Steljes | Dental Hygienist | Building 13128 14th Street, Camp Pendleton, CA 92055-5221 | 2020-10-22 |
1427657261 | Julie Lynn March | Dental Hygienist | 19871 Mitscher Way Bldg 2495, San Diego, CA 92145-5103 | 2020-10-22 |
1386243327 | Leticia Isabel Alcantar | Dental Hygienist | Bldg 520448, Camp Pendleton, CA 92055 | 2020-10-21 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.