Provider Demographics
NPI:1083828461
Name:JAGER, SIOBHAN S (RDH)
Entity Type:Individual
Prefix:MS
First Name:SIOBHAN
Middle Name:S
Last Name:JAGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GRAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5554
Mailing Address - Country:US
Mailing Address - Phone:860-714-4990
Mailing Address - Fax:860-174-8005
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-4990
Practice Address - Fax:860-714-8005
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004146124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004146OtherDENTAL HYGIENIST LICENSE