Healthcare Provider Details

I. General information

NPI: 1710895255
Provider Name (Legal Business Name): JILL NICOLE ANDERSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N LURING DR STE A
PALM SPRINGS CA
92262-6841
US

IV. Provider business mailing address

7344 WARREN VISTA AVE
YUCCA VALLEY CA
92284-3844
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-2771
  • Fax:
Mailing address:
  • Phone: 951-655-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number36219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: