Provider Demographics
NPI:1831967892
Name:WILLIAMSON, SASHA N (RDH, PHDHP)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:N
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:MRS
Other - First Name:SASHA
Other - Middle Name:N
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH,PHDHP
Mailing Address - Street 1:2492 JOBS RUN RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-8940
Mailing Address - Country:US
Mailing Address - Phone:171-798-2102
Mailing Address - Fax:
Practice Address - Street 1:2039 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1206
Practice Address - Country:US
Practice Address - Phone:717-982-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH070876124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist