Provider Demographics
NPI:1730272394
Name:WHITFIELD, MARIANNE (RDH)
Entity type:Individual
Prefix:MISS
First Name:MARIANNE
Middle Name:
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CAMINO CORTO
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-3590
Mailing Address - Country:US
Mailing Address - Phone:707-765-7234
Mailing Address - Fax:707-765-7521
Practice Address - Street 1:599 TOMALES RD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5002
Practice Address - Country:US
Practice Address - Phone:707-765-7234
Practice Address - Fax:707-765-7521
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH18824124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDH18824OtherRDH LICENSE