Provider Demographics
NPI:1184459240
Name:BERTHELSON, JESSICA LYNN (RDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BERTHELSON
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 1:4747 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-9528
Mailing Address - Country:US
Mailing Address - Phone:970-620-0932
Mailing Address - Fax:
Practice Address - Street 1:729 WATER ST
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641-3400
Practice Address - Country:US
Practice Address - Phone:970-878-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000905178124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist