Provider Demographics
NPI:1831595107
Name:KLIMKEWICZ, JODYANN MARIE (RDH)
Entity type:Individual
Prefix:
First Name:JODYANN
Middle Name:MARIE
Last Name:KLIMKEWICZ
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 1:198 GIBSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CT
Mailing Address - Zip Code:06377-1919
Mailing Address - Country:US
Mailing Address - Phone:860-978-5382
Mailing Address - Fax:
Practice Address - Street 1:94 CONNECTICUIT BLVD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-528-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006866124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist