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General NPI Number Information
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NPI Number | 1497563480
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Entity Type | Individual
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Provider Name | JAIME DAHL
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Gender | Female
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 16387 FIRST ST FL 3
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City | GUERNEVILLE
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State | CA
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Zip | 95446-8817
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Country | US
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Telephone | 707-869-2933
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Fax |
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Provider Business Mailing Address
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Address Line | 656 SPARKES RD
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City | SEBASTOPOL
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State | CA
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Zip | 95472-5043
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Country | US
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Telephone | 707-484-9339
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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 | 23924
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License Number State | CA
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