Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 9401 | AZ |
NPI | 1013529684 |
---|---|
Provider Name | Jordyn Rippberger |
First Address | Salt Lake City, UT 84127-0358 |
Second Address | Marana, AZ 85653-7008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2020 |
Last Update Date | 29/03/2021 |