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General NPI Number Information
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NPI Number | 1629835467
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Entity Type | Individual
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Provider Name | LAURIE JIMENEZ RDH
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Gender | Female
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 900 CHAPEL ST APT RC245
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City | NEW HAVEN
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State | CT
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Zip | 06510-2822
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Country | US
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Telephone | 703-944-0637
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Fax |
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Provider Business Mailing Address
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Address Line | 206 ELM ST # 4719
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City | NEW HAVEN
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State | CT
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Zip | 06520-9251
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Country | US
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Telephone | 703-944-0637
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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 | 0402207265
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License Number State | VA
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