Lebrock Shynnel Blystone, RDA

NPI #1205232204 in Baldwin Park, California

Provider Information

NPI Number: 1205232204
Entity Type: Individual
Name: Lebrock Shynnel Blystone, RDA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Credential: RDA
Enumeration Date: Nov 18, 2014
Last Updated: Nov 18, 2014

Practice Location

Address: 4000 LA RICA AVE
Address 2: STE D
City: Baldwin Park
State: California
ZIP Code: 91706-3163
Phone: (626) 430-9171

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Assistant	126800000X	Primary

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