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General NPI Number Information
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NPI Number | 1053199786
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Entity Type | Individual
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Provider Name | JEANNE MARIE CUMMINGS RDH
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Gender | Female
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 317 SANDERS WAY
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City | GOLDENDALE
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State | WA
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Zip | 98620-9059
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Country | US
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Telephone | 509-773-4017
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1372
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City | GOLDENDALE
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State | WA
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Zip | 98620-1372
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Country | US
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Telephone | 509-261-0661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00006290
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License Number State | WA
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