Healthcare Provider Details

I. General information

NPI: 1871221663
Provider Name (Legal Business Name): MADELINE KIBLER RDH, RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 FERRY ST
ANDERSON CA
96007-3365
US

IV. Provider business mailing address

PO BOX 1203
SHASTA LAKE CA
96019-1203
US

V. Phone/Fax

Practice location:
  • Phone: 530-378-4185
  • Fax:
Mailing address:
  • Phone: 530-638-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31175
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: