Provider Demographics
NPI:1225588189
Name:CENICEROS, JOCELYN (RDH)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:CENICEROS
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 1:3730 S 52ND CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4417
Mailing Address - Country:US
Mailing Address - Phone:708-574-0513
Mailing Address - Fax:
Practice Address - Street 1:3730 S 52ND CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4417
Practice Address - Country:US
Practice Address - Phone:708-574-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020015424124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist