Provider Demographics
NPI:1871679332
Name:JARAMILLO, ADRIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2137
Mailing Address - Country:US
Mailing Address - Phone:608-873-6464
Mailing Address - Fax:608-873-4866
Practice Address - Street 1:221 S WATER ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-2137
Practice Address - Country:US
Practice Address - Phone:608-873-6464
Practice Address - Fax:608-873-4866
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56140151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33782500Medicaid