ICBOGGAN, INC (NPI# 1962035261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962035261 |
| Entity Type | Organization |
| Organization Name | ICBOGGAN, INC |
| Other Organization Name | OROFACIAL FITNESS |
| Practice Address |
3799 Mt Diablo Blvd Unit 200 Lafayette CA 94549-3545 |
| Mailing Address |
3202 Ortega Ave Lafayette CA 94549-3225 |
| Practice Telephone | 9259627450 |
| Enumeration Date | 2020-02-15 |
| Last Update Date | 2020-02-15 |
| Authorized Official Name | NERISSA T BOGGAN (RDH) |
| Authorized Official Telephone | 9259627450 |
| Authorized Official Credential | RDH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | Dental Providers |
| Other Name | Type Code |
|---|---|
| Nerissa T. Boggan | Doing Business As Name - Organization |
| Orofacial Fitness | Doing Business As Name - Organization |
| Street Address |
3799 MT DIABLO BLVD UNIT 200 |
| City | LAFAYETTE |
| State | CA |
| Zip Code | 94549-3545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427004 | Veronica Adelaid Valera-averilla | Behavior Technician | 3650 Mt Diablo Blvd. Ste. 107, Lafayette Ca Contra, CA 94549 | 2020-11-06 |
| 1679128870 | Zong Ning Zhou | Behavior Technician | 3650 Mt.diablo Blvd., Suite 107, Lafayette, CA 94549 | 2019-08-05 |
| 1912551227 | Tamiesha Jackson | Behavior Technician | Ste Consultant, LLC, 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2019-07-25 |
| 1528525375 | Tiara Lajai Aubrey | Behavior Technician | 3560 Mt. Diablo Blvd, Suite 107, Layfatte, CA 94549 | 2019-02-28 |
| 1215409990 | Marisa Della Marmolejo | Case Manager/Care Coordinator | Ste Consultants, LLC 3650 Mt Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-12-19 |
| 1235608399 | Andrew Thompson | Behavior Technician | 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2018-11-19 |
| 1982172953 | Amber Jackson | Behavior Technician | Ste, LLC, 3650 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-11-08 |
| 1104393396 | Alexis Taper | Behavior Technician | Ste Consultants LLC, 3650 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-10-26 |
| 1023508793 | Alyssa Savinovich | Behavior Technician | 3560 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-05-17 |
| 1831689140 | Kannambra M Raja | Behavior Technician | Ste Consultants LLC, 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2018-05-11 |
| Find all providers in zip 94549 | ||||
| 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 |
|---|---|---|---|---|
| 1508428749 | Nina M Cachanosky | Dental Hygienist | 1735 S Public Rd Ste 101, Lafayette, CO 80026-7093 | 2019-07-08 |
| 1265070569 | Cathy Wing Chan | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2019-12-17 |
| 1750865838 | Chairel Thomas | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2018-09-24 |
| 1639658859 | Miranda Clark | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2018-08-08 |
| 1548705718 | Kalah Ross | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-12-27 |
| 1790237741 | Sarah Renfro | Dental Hygienist | 1285 Centaur Village Dr, Suite 200, Lafayette, CO 80026-1214 | 2016-10-25 |
| 1265982193 | Rachel Sobieck | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-10-04 |
| 1003361346 | Jessica Jensen | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-08-16 |
| 1114338852 | Criselda Sanchez | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2014-05-15 |
| 1649400235 | Sara Lynn Nolen | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2009-07-17 |
| Find all providers in LAFAYETTE | ||||
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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.