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General NPI Number Information
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NPI Number | 1770210783
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Entity Type | Individual
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Provider Name | KIMBERLY MENJIVAR RDH
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Gender | Female
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 509 ORANGE ST
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City | NEWARK
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State | NJ
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Zip | 07107-2128
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Country | US
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Telephone | 973-481-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SPRUCE ST
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City | KEARNY
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State | NJ
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Zip | 07032-3531
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Country | US
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Telephone | 201-496-4246
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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 | 22HI01177400
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License Number State | NJ
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