Provider Demographics
NPI:1598918823
Name:MILTON, JENNIFER AUBREY (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AUBREY
Last Name:MILTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4430
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-4007
Mailing Address - Country:US
Mailing Address - Phone:509-303-9700
Mailing Address - Fax:
Practice Address - Street 1:358 GREENBROOK PL
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9628
Practice Address - Country:US
Practice Address - Phone:509-303-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH 60035039124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADH 60035036OtherWASHINGTON STATE DEPARTMENT OF HEALTH