Basic Information
Provider Information
NPI: 1407998057
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LISTOE
FirstName: CINDY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: R.D.H.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1620 TANBARK DR
Address2:  
City: RED BLUFF
State: CA
PostalCode: 960803253
CountryCode: US
TelephoneNumber: 5305290441
FaxNumber:  
Practice Location
Address1: 1425 MONTGOMERY RD
Address2:  
City: RED BLUFF
State: CA
PostalCode: 960804605
CountryCode: US
TelephoneNumber: 5305288600
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/12/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000XRDH17315CAY Dental ProvidersDental Hygienist 

No ID Information.


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