Healthcare Provider Details

I. General information

NPI: 1194977751
Provider Name (Legal Business Name): JEAN MARGARET HONNY MSDH, RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18775 CHICKORY DR
RIVERSIDE CA
92504-9526
US

IV. Provider business mailing address

18775 CHICKORY DR
RIVERSIDE CA
92504-9526
US

V. Phone/Fax

Practice location:
  • Phone: 951-789-7128
  • Fax:
Mailing address:
  • Phone: 951-789-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH 17760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: