Provider Demographics
NPI:1255816377
Name:MCBRIDE, JONNIE LEANNE (EPDH)
Entity type:Individual
Prefix:
First Name:JONNIE
Middle Name:LEANNE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82504 HOWE LN
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9309
Mailing Address - Country:US
Mailing Address - Phone:541-643-1982
Mailing Address - Fax:
Practice Address - Street 1:82504 HOWE LN
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9309
Practice Address - Country:US
Practice Address - Phone:541-643-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6350124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist