Healthcare Provider Details

I. General information

NPI: 1821332479
Provider Name (Legal Business Name): JESSICA LEE WILLIAMS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 CROWN AVE #200
LANCASTER PA
17601-6322
US

IV. Provider business mailing address

101 NEW HAVEN ST APT B APT B
MOUNT JOY PA
17552-2212
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax:
Mailing address:
  • Phone: 814-440-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH069789
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: