Provider Demographics
NPI:1750997938
Name:DEFENDIS, NATASHA (RDH)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:DEFENDIS
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 1:3130 ALTA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9252
Mailing Address - Country:US
Mailing Address - Phone:760-533-3063
Mailing Address - Fax:
Practice Address - Street 1:3130 ALTA VERDE DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-9252
Practice Address - Country:US
Practice Address - Phone:760-533-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31840124Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty