Healthcare Provider Details

I. General information

NPI: 1851215701
Provider Name (Legal Business Name): LUCAS JERICHO SWANSON RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MAIN ST
RED BLUFF CA
96080-2336
US

IV. Provider business mailing address

2500 MAIN ST
RED BLUFF CA
96080-2336
US

V. Phone/Fax

Practice location:
  • Phone: 530-529-2567
  • Fax:
Mailing address:
  • Phone: 530-529-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number33219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: