Provider Demographics
NPI:1144640368
Name:TODD, JODI (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 SARATOGA CT
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4187
Mailing Address - Country:US
Mailing Address - Phone:707-272-4426
Mailing Address - Fax:
Practice Address - Street 1:244 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4557
Practice Address - Country:US
Practice Address - Phone:707-272-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 22675124Q00000X
CAHAP 517124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist