Jessica Ann Thaler, RDH

Key facts

NPI

1295370559

Entity type

Individual (NPI type 1)

Primary specialty

Dental Hygienist 124Q00000X

License

026775 (NY)

Practice address

3761 Main St
Warrensburg, NY 12885-1837

Phone

(518) 623-3918

Fax

(518) 623-4330

NPI assigned

Nov 11, 2019

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 11, 2019.

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1295370559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3761 MAIN ST",
            "city": "WARRENSBURG",
            "state": "NY",
            "postal_code": "128851837",
            "telephone_number": "518-623-3918",
            "fax_number": "518-623-4330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THALER",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NY",
            "license": "026775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Warrensburg, NY · Dental Hygienist in New York