Provider Demographics
NPI:1649417247
Name:JIANNETTI, GINA MARIE (RDH)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:JIANNETTI
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 1:11577 W 38TH PL
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3803
Mailing Address - Country:US
Mailing Address - Phone:303-422-3175
Mailing Address - Fax:303-940-4911
Practice Address - Street 1:11577 W 38TH PL
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3803
Practice Address - Country:US
Practice Address - Phone:303-422-3175
Practice Address - Fax:303-940-4911
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201274124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist