MEDICARE: JESSICA LINDLEY RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	7155	TN

General Provider Information

NPI Number	:	1952026023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LINDLEY RDH

Provider Business Mailing Address
First Line	:	195 PINE RIDGE LN
Second Line	:
City	:	OAKLAND
State	:	TN
Zip	:	38060-4177
Country	:	US
Telephone Number	:	901-921-0989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 S HOUSTON LEVEE RD STE 126
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-6970
Country	:	US
Telephone Number	:	901-425-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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