Healthcare Provider Details

I. General information

NPI: 1225115454
Provider Name (Legal Business Name): JENNIFER M CONTRERAS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W WETMORE RD
TUCSON AZ
85705-1521
US

IV. Provider business mailing address

8240 E NICARAGUA DR
TUCSON AZ
85730-3509
US

V. Phone/Fax

Practice location:
  • Phone: 520-293-4510
  • Fax:
Mailing address:
  • Phone: 520-207-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4923
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: