Healthcare Provider Details

I. General information

NPI: 1760987614
Provider Name (Legal Business Name): REDLANDS ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TERRACINA BLVD SUITE 207 B
REDLANDS CA
92373
US

IV. Provider business mailing address

245 TERRACINA BLVD STE 207B
REDLANDS CA
92373-4869
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-2228
  • Fax: 909-798-2224
Mailing address:
  • Phone: 909-798-2228
  • Fax: 909-798-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number59904
License Number StateCA

VIII. Authorized Official

Name: JENELLE MEREDITH SILVERS
Title or Position: ENDODONTIST
Credential: DDS
Phone: 717-514-8227