Healthcare Provider Details

I. General information

NPI: 1912396581
Provider Name (Legal Business Name): JESSICA HELTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S NEW YORK AVE
WELLSTON OH
45692-1540
US

IV. Provider business mailing address

195 BUCK HOLLOW RD
BEAVER OH
45613-9498
US

V. Phone/Fax

Practice location:
  • Phone: 740-384-5119
  • Fax: 740-384-5405
Mailing address:
  • Phone: 740-835-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31-014259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: