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General NPI Number Information
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NPI Number | 1962649715
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Entity Type | Individual
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Provider Name | JESSICA LYNN WOODS RDA, RDH, RDHAP
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Gender | Female
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 407 W IMPERIAL HWY SUITE H175
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City | BREA
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State | CA
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Zip | 92821-4832
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Country | US
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Telephone | 714-292-3291
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Fax |
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Provider Business Mailing Address
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Address Line | 407 W IMPERIAL HWY SUITE H175
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City | BREA
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State | CA
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Zip | 92821-4832
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Country | US
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Telephone | 714-292-3291
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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 | 25954
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HAP542
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 64252
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 102237
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License Number State | NV
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