MEDICARE: MRS. JAMESA TREADWELL RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH00004959	WA

General Provider Information

NPI Number	:	1013483775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMESA TREADWELL RDH

Provider Business Mailing Address
First Line	:	1662 BOON RD
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-8400
Country	:	US
Telephone Number	:	360-929-9714
Fax Number	:

Provider Business Practice Location Address
First Line	:	1662 BOON RD
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-8400
Country	:	US
Telephone Number	:	360-929-9714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2018
Last Update Date	:	10/21/2018

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