MEDICARE: JILNA RAICHURA RDH, MS

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	5358	MD

General Provider Information

NPI Number	:	1518724319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILNA RAICHURA RDH, MS

Provider Business Mailing Address
First Line	:	4412 SKYMIST TER
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-2824
Country	:	US
Telephone Number	:	202-262-4870
Fax Number	:

Provider Business Practice Location Address
First Line	:	16815 CRABBS BRANCH WAY
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20855-2215
Country	:	US
Telephone Number	:	301-963-4330
Fax Number	:

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

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/28/2024

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