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General NPI Number Information
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NPI Number | 1760987614
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Entity Type | Organization
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Legal Business Name | REDLANDS ENDODONTICS
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 245 TERRACINA BLVD SUITE 207 B
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-798-2228
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Fax | 909-798-2224
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Provider Business Mailing Address
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Address Line | 245 TERRACINA BLVD STE 207B
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City | REDLANDS
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State | CA
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Zip | 92373-4869
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Country | US
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Telephone | 909-798-2228
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Fax | 909-798-2224
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Authorized Official
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Title or Position | ENDODONTIST
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Name | JENELLE MEREDITH SILVERS
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Credential | DDS
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Telephone | 717-514-8227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 59904
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License Number State | CA
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