Provider Demographics
NPI:1396962825
Name:BALDWIN, JESSEE RACHAEL (RDH)
Entity type:Individual
Prefix:
First Name:JESSEE
Middle Name:RACHAEL
Last Name:BALDWIN
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 1:1262 HARPOLE RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2917
Mailing Address - Country:US
Mailing Address - Phone:530-222-1255
Mailing Address - Fax:
Practice Address - Street 1:20623 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4380
Practice Address - Country:US
Practice Address - Phone:530-335-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21346124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist