Individual
EDITH SOCORRO GONZALEZ JAIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
121 PARK HILL DR., SUITE A, FREDERICKSBURG, VA 22401
(540) 373-1660
Mailing address
PO BOX 4947, GLEN ALLEN, VA 23058
(540) 223-5602
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417411
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2018
Last updated
08/10/2021
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