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General NPI Number Information
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NPI Number | 1184459240
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Entity Type | Individual
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Provider Name | JESSICA LYNN BERTHELSON RDH
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Gender | Female
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 729 WATER ST
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City | MEEKER
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State | CO
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Zip | 81641-3400
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Country | US
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Telephone | 970-878-9967
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Fax |
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Provider Business Mailing Address
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Address Line | 4747 COUNTY ROAD 8
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City | MEEKER
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State | CO
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Zip | 81641-9528
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Country | US
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Telephone | 970-620-0932
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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.000905178
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License Number State | CO
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