Healthcare Provider Details

I. General information

NPI: 1457263923
Provider Name (Legal Business Name): JACLYN MILLER RDH, PHDHP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E WALNUT ST STE 2
LOCK HAVEN PA
17745-3522
US

IV. Provider business mailing address

471 HEPBURN ST
WILLIAMSPORT PA
17701-6122
US

V. Phone/Fax

Practice location:
  • Phone: 570-567-5400
  • Fax: 877-551-9931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH075062
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: