Individual
SHELLY ANNE WITHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, RDH, MS
Contact information
Practice address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4631
(909) 558-0313
Mailing address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4631
(909) 558-0313
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H5578
OR
124Q00000X
Dental Hygienist
Primary
RDH 19010
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RDH 19010
STATE LICENSE
CA
Enumeration date
10/21/2008
Last updated
10/15/2014
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