1194634923 NPI number — SODA DENTAL HYGIENE PRACTICE OF ASHLEY SHELLEY RDHAP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194634923 NPI number — SODA DENTAL HYGIENE PRACTICE OF ASHLEY SHELLEY RDHAP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SODA DENTAL HYGIENE PRACTICE OF ASHLEY SHELLEY RDHAP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1194634923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9453 AVENIDA SAN TIMOTEO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92223-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-213-7537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 BROOKSIDE AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92373-5189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-213-7537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2026

Additional Information

Authorized Official

Authorized Official Last Name:
SHELLEY
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
909-213-7537

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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