Healthcare Provider Details

I. General information

NPI: 1689882953
Provider Name (Legal Business Name): JOANNE FRANCES CERRONE DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

51 KNEELAND RD
NEW HAVEN CT
06512-5006
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3044
  • Fax: 203-503-3187
Mailing address:
  • Phone: 203-469-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number001805
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: