Healthcare Provider Details

I. General information

NPI: 1518724319
Provider Name (Legal Business Name): JILNA RAICHURA RDH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 CRABBS BRANCH WAY
ROCKVILLE MD
20855-2215
US

IV. Provider business mailing address

4412 SKYMIST TER
OLNEY MD
20832-2824
US

V. Phone/Fax

Practice location:
  • Phone: 301-963-4330
  • Fax:
Mailing address:
  • Phone: 202-262-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5358
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: