Provider Demographics
NPI:1891565396
Name:SIMONEAU, SEREENA G (RDH)
Entity Type:Individual
Prefix:
First Name:SEREENA
Middle Name:G
Last Name:SIMONEAU
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 1:195 MILL STREET
Mailing Address - Street 2:B
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464
Mailing Address - Country:US
Mailing Address - Phone:802-752-0578
Mailing Address - Fax:
Practice Address - Street 1:195 MILL ST # B
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464-9572
Practice Address - Country:US
Practice Address - Phone:802-752-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT015.0001608124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist