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General NPI Number Information
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NPI Number | 1780938050
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Entity Type | Individual
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Provider Name | JILL RATCLIFFE QUAST R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 1750 MAIN ST SAND SCHOOL DENTAL CLINIC
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City | HARTFORD
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State | CT
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Zip | 06120-2312
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Country | US
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Telephone | 860-695-5056
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Fax |
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Provider Business Mailing Address
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Address Line | 31 SPRING GLEN DR
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City | GRANBY
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State | CT
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Zip | 06035-2624
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Country | US
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Telephone | 860-305-5410
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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 | 02899
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License Number State | CT
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