Provider Demographics
NPI:1508268798
Name:MCMULLIN, JESSICA PORAZINSKI (RDH, MPH)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PORAZINSKI
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:RDH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 MIDDLETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3806
Mailing Address - Country:US
Mailing Address - Phone:860-436-3076
Mailing Address - Fax:
Practice Address - Street 1:960 MAIN STREET
Practice Address - Street 2:HEALTH SERVICES, 9TH FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1225
Practice Address - Country:US
Practice Address - Phone:860-882-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006570124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist