Healthcare Provider Details

I. General information

NPI: 1396157475
Provider Name (Legal Business Name): DR. NATALIA SANCHEZ MENJIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CHASE PKWY
WATERBURY CT
06708-3046
US

IV. Provider business mailing address

44 WALBRIDGE RD
WEST HARTFORD CT
06119-1343
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-8034
  • Fax:
Mailing address:
  • Phone: 262-497-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberR547
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: