Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 7843 | CT |
NPI | 1063958502 |
---|---|
Provider Name | Jessica Henrick |
First Address | West Haven, CT 06516-6250 |
Second Address | New Haven, CT 06519-1783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2017 |
Last Update Date | 09/01/2017 |