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General NPI Number Information
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NPI Number | 1144191438
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Entity Type | Individual
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Provider Name | JESSICA D SWANCY RDH
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 306 MAIN STREET SUITE 3
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City | KAMIAH
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State | ID
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Zip | 83536
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Country | US
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Telephone | 208-935-2143
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Fax |
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Provider Business Mailing Address
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Address Line | 1751 GIBLER RD
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City | KAMIAH
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State | ID
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Zip | 83536-5004
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Country | US
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Telephone | 208-871-5483
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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 | DH-3257
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License Number State | ID
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