MEDICARE: JENNIFER VALENZANO 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	22H100882700	NJ

General Provider Information

NPI Number	:	1275292435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER VALENZANO RDH

Provider Business Mailing Address
First Line	:	8 S 7TH ST
Second Line	:
City	:	DEL HAVEN
State	:	NJ
Zip	:	08251-3409
Country	:	US
Telephone Number	:	215-620-8392
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 S 7TH ST
Second Line	:
City	:	DEL HAVEN
State	:	NJ
Zip	:	08251-3409
Country	:	US
Telephone Number	:	215-620-8392
Fax Number	:

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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