MEDICARE: MS. JENNIFER M CONTRERAS RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H4923	AZ

General Provider Information

NPI Number	:	1225115454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER M CONTRERAS RDH

Provider Business Mailing Address
First Line	:	8240 E NICARAGUA DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-3509
Country	:	US
Telephone Number	:	520-207-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 W WETMORE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1521
Country	:	US
Telephone Number	:	520-293-4510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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