Healthcare Provider Details

I. General information

NPI: 1194634923
Provider Name (Legal Business Name): SODA DENTAL HYGIENE PRACTICE OF ASHLEY SHELLEY RDHAP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BROOKSIDE AVE STE 102
REDLANDS CA
92373-5189
US

IV. Provider business mailing address

9453 AVENIDA SAN TIMOTEO
CHERRY VALLEY CA
92223-4315
US

V. Phone/Fax

Practice location:
  • Phone: 909-213-7537
  • Fax:
Mailing address:
  • Phone: 909-213-7537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ASHLEY NICOLE SHELLEY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 909-213-7537