Healthcare Provider Details

I. General information

NPI: 1316773385
Provider Name (Legal Business Name): JENNIFER DYKE RDH, PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3225 SALMON ST
PHILADELPHIA PA
19134-5909
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2900
  • Fax:
Mailing address:
  • Phone: 215-906-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH001093
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH012151L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: