Kenna Rose Tyree, RDH
Individual provider Active NPI Dental Hygienist · Round Mountain, CA
NPI 1013474501 · NPPES record last updated Feb 21, 2019
Key facts
- NPI
- 1013474501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 30456 (CA)
- Practice address
- 29632 Highway 299 East
Round Mountain, CA 96084 - Phone
- (530) 337-6244
- NPI assigned
- Feb 21, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 30456 | CA | Yes |
Addresses
Primary practice location
29632 Highway 299 East
Round Mountain, CA 96084
Mailing address
PO Box 228
Round Mountain, CA 96084-0228
Phone (530) 337-6244
Other providers in Round Mountain, CA
- Christopher David Nelson
- Hannah McKenzie Pearson
- Jaclyn Romo
- Happy Star Shaw
- William Hunter Sutherland
- Alexandria Walesch
- Lisa Rena Williams
All providers in Round Mountain, CA · Dental Hygienist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.