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General NPI Number Information
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NPI Number | 1245871474
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Entity Type | Individual
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Provider Name | JENNIFER MEDINA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 09/29/2019
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Provider Practice Location Address
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Address Line | 126 AUDUBON AVE
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City | BRAINTREE
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State | MA
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Zip | 02184-2352
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Country | US
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Telephone | 617-913-3321
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Fax | 781-817-6135
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Provider Business Mailing Address
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Address Line | 126 AUDUBON AVE
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City | BRAINTREE
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State | MA
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Zip | 02184-2352
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Country | US
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Telephone | 617-913-3321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH88211
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License Number State | MA
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