=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235683178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOFIYA GERMAN I
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2016
-----------------------------------------------------
Last Update Date | 08/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 NORTHWEST DR
-----------------------------------------------------
City | PLAINVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06062-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-584-6555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 ACORN LN
-----------------------------------------------------
City | UNIONVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06085-1575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 006174
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------