Active NPI
Shelly Anne Withers, BS, RDH, MS
- Dental Hygienist
- Loma Linda, CA
National Provider Identifier
1689826653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- RDH 19010
- Practice address
- 11092 Anderson St
Loma Linda, CA 92350-1706 - Phone
- (909) 558-4631
- Fax
- (909) 558-0313
- NPI assigned
- Oct 21, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | RDH 19010 | CA | Primary |
| Dental Hygienist | 124Q00000X | H5578 | OR |
Addresses
Primary practice location
11092 Anderson St
Loma Linda, CA 92350-1706
Mailing address
11092 Anderson St
Loma Linda, CA 92350-1706
Phone (909) 558-4631
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RDH 19010 | Other | CA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RDH 19010 | CA | MD | Dental Hygienist |
| H5578 | OR | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413331200000",
"number": "1689826653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11092 ANDERSON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501706",
"telephone_number": "909-558-4631",
"fax_number": "909-558-0313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11092 ANDERSON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501706",
"telephone_number": "909-558-4631",
"fax_number": "909-558-0313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITHERS",
"first_name": "SHELLY",
"middle_name": "ANNE",
"credential": "BS, RDH, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-21",
"last_updated": "2014-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "RDH 19010",
"primary": true
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "OR",
"license": "H5578",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "RDH 19010",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.