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General NPI Number Information
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NPI Number | 1720387210
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Entity Type | Individual
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Provider Name | REOLA JIMPERSON MOSS RDH
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Gender | Female
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 16 W 137TH ST WP BLDG. 2ND FL.
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City | NEW YORK
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State | NY
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Zip | 10037-1901
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Country | US
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Telephone | 212-939-1000
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Fax | 212-939-2885
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Provider Business Mailing Address
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Address Line | 123 E 129TH ST APT. 6N
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City | NEW YORK
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State | NY
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Zip | 10035-1117
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Country | US
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Telephone | 212-939-1000
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Fax | 212-939-2885
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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 | 017591
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License Number State | NY
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