Healthcare Provider Details

I. General information

NPI: 1487337937
Provider Name (Legal Business Name): KIERESTEN R ANDERSON RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 S CHINA LAKE BLVD STE D
RIDGECREST CA
93555-4669
US

IV. Provider business mailing address

459 S CHINA LAKE BLVD STE D
RIDGECREST CA
93555-4669
US

V. Phone/Fax

Practice location:
  • Phone: 760-428-8837
  • Fax:
Mailing address:
  • Phone: 760-608-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: