Active NPI
Brienne R Lake, RDH
- Dental Hygienist
- Sacramento, CA
National Provider Identifier
1881375178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 23969
- Practice address
- 3835 Freeport Blvd
Sacramento, CA 95822-1318 - Phone
- (707) 337-0726
- NPI assigned
- Jul 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 23969 | CA | Primary |
Addresses
Primary practice location
3835 Freeport Blvd
Sacramento, CA 95822-1318
Mailing address
4848 Tusk Way
Elk Grove, CA 95757-1724
Phone (707) 337-0726
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23969 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690502400000",
"number": "1881375178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4848 TUSK WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957571724",
"telephone_number": "707-337-0726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3835 FREEPORT BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958221318",
"telephone_number": "707-337-0726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "BRIENNE",
"middle_name": "R",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-28",
"last_updated": "2023-07-28",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "23969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.