1548748601 NPI number — JESSICA MICHELE OAKS RDH

Table of content: JESSICA MICHELE OAKS RDH (NPI 1548748601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548748601 NPI number — JESSICA MICHELE OAKS RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OAKS
Provider First Name:
JESSICA
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548748601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80443-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-668-4055
Provider Business Mailing Address Fax Number:
970-668-9433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HAMILTON CREEK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERTHORNE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-668-4055
Provider Business Practice Location Address Fax Number:
970-668-9433
Provider Enumeration Date:
08/01/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  DH.002025203 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DH.002025203 . This is a "DENTAL HYGIENIST LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".