Provider Demographics
NPI:1023825114
Name:MOTEN, DINNESHIA ANNETTA (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:DINNESHIA
Middle Name:ANNETTA
Last Name:MOTEN
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 SKATE CT APT A
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-1134
Mailing Address - Country:US
Mailing Address - Phone:256-770-9022
Mailing Address - Fax:
Practice Address - Street 1:USS OSBORNE DENTAL CLINIC
Practice Address - Street 2:3440 OHIO ST
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10503124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist