Individual
JESSICA LAUREN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1413 GOLD BUCKLE CT, REDLANDS, CA 92374-2790
(909) 904-1891
Mailing address
1413 GOLD BUCKLE CT, REDLANDS, CA 92374-2790
(909) 904-1891
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
24820
CA
Other
Enumeration date
05/30/2012
Last updated
05/30/2012
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