Healthcare Provider Details

I. General information

NPI: 1386514206
Provider Name (Legal Business Name): THE VIRTUAL HYGEINIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SALAZAR ST
SAINT AUGUSTINE FL
32095-6639
US

IV. Provider business mailing address

115 SALAZAR ST
SAINT AUGUSTINE FL
32095-6639
US

V. Phone/Fax

Practice location:
  • Phone: 904-603-8323
  • Fax:
Mailing address:
  • Phone: 904-603-8323
  • 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: JESSICA BETHEL
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDH
Phone: 904-603-8323