Individual
JESSICA ANN BERNOTSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
0402205335
VA
124Q00000X
Dental Hygienist
Primary
5368500-9920
UT
Other
Enumeration date
05/25/2015
Last updated
05/25/2015
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