Provider Demographics
NPI:1558080994
Name:SINGH, JYOTSANA (RDHAP)
Entity Type:Individual
Prefix:
First Name:JYOTSANA
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SWAINSONS CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-5516
Mailing Address - Country:US
Mailing Address - Phone:925-474-4402
Mailing Address - Fax:
Practice Address - Street 1:5300 SWAINSONS CT
Practice Address - Street 2:MOBILE UNIT
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521
Practice Address - Country:US
Practice Address - Phone:925-474-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP919125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty