Healthcare Provider Details

I. General information

NPI: 1316830276
Provider Name (Legal Business Name): JESSICA CODY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ALCOTT ST
ACTON MA
01720-5540
US

IV. Provider business mailing address

51 ALCOTT ST
ACTON MA
01720-5540
US

V. Phone/Fax

Practice location:
  • Phone: 419-343-7471
  • Fax:
Mailing address:
  • Phone: 419-343-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH87586
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: