Healthcare Provider Details

I. General information

NPI: 1144803628
Provider Name (Legal Business Name): JENEE MONETTE NEWMAN RDH,RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21801 STONE PL
TEHACHAPI CA
93561-8909
US

IV. Provider business mailing address

21801 STONE PL
TEHACHAPI CA
93561-8909
US

V. Phone/Fax

Practice location:
  • Phone: 661-340-6131
  • Fax:
Mailing address:
  • Phone: 661-340-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: