Healthcare Provider Details

I. General information

NPI: 1700530243
Provider Name (Legal Business Name): JENNIFER P ALLBRIGHT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER P BAKER RDH

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 IVY AVE STE B
TILLAMOOK OR
97141-3758
US

IV. Provider business mailing address

PO BOX 489
TILLAMOOK OR
97141-0489
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-3929
  • Fax: 503-842-6099
Mailing address:
  • Phone: 503-842-3929
  • Fax: 503-842-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: