Individual
JESSICA AREVALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2050 TILDEN AVE, NEW HARTFORD, NY 13413-3613
(315) 737-2448
Mailing address
2050 TILDEN AVE, PO BOX 1000, NEW HARTFORD, NY 13413-3613
(315) 737-2448
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
022595-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00313539
—
NY
05
—
01815443
—
NY
Enumeration date
02/10/2016
Last updated
02/10/2016
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