Provider Demographics
NPI:1962649715
Name:WOODS, JESSICA LYNN (RDA, RDH, RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:WOODS
Suffix:
Gender:F
Credentials:RDA, RDH, RDHAP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:HOLLERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA, RDH
Mailing Address - Street 1:407 W IMPERIAL HWY
Mailing Address - Street 2:SUITE H175
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4832
Mailing Address - Country:US
Mailing Address - Phone:714-292-3291
Mailing Address - Fax:
Practice Address - Street 1:407 W IMPERIAL HWY
Practice Address - Street 2:SUITE H175
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4832
Practice Address - Country:US
Practice Address - Phone:714-292-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25954124Q00000X
CAHAP542124Q00000X
CA64252126800000X
NV102237124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant