Healthcare Provider Details

I. General information

NPI: 1396962825
Provider Name (Legal Business Name): JESSEE RACHAEL BALDWIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20623 COMMERCE WAY
BURNEY CA
96013-4380
US

IV. Provider business mailing address

1262 HARPOLE RD
REDDING CA
96002-2917
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-2272
  • Fax:
Mailing address:
  • Phone: 530-222-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number21346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: