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General NPI Number Information
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NPI Number | 1891565396
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Entity Type | Individual
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Provider Name | SEREENA G SIMONEAU RDH
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Gender | Female
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 195 MILL ST # B
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City | JEFFERSONVILLE
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State | VT
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Zip | 05464-9572
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Country | US
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Telephone | 802-752-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 195 MILL STREET B
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City | JEFFERSONVILLE
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State | VT
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Zip | 05464
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Country | US
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Telephone | 802-752-0578
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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 | 015.0001608
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License Number State | VT
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