Basic Information
| Provider Information | |||||||||
| NPI: | 1336289131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERWILLIGER | ||||||||
| FirstName: | MINDY | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 162 | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302993428 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 554 850 MEDICAL CENTER DR. | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302945241 | ||||||||
| FaxNumber: | 5302945392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 20830 | CA | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | 20830 | 01 | CA | REGISTERED DENTAL HYGIENS | OTHER |