Provider Demographics
NPI:1164102844
Name:ARNOLD, GRETCHEN VENEZIA (RDH)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:VENEZIA
Last Name:ARNOLD
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 1:47 RIMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1854
Mailing Address - Country:US
Mailing Address - Phone:860-836-8796
Mailing Address - Fax:
Practice Address - Street 1:763 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2791
Practice Address - Country:US
Practice Address - Phone:860-291-9154
Practice Address - Fax:860-291-9728
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005378124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist