Provider Demographics
NPI:1396157475
Name:MENJIVAR, NATALIA SANCHEZ
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:SANCHEZ
Last Name:MENJIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WALBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1343
Mailing Address - Country:US
Mailing Address - Phone:262-497-5693
Mailing Address - Fax:
Practice Address - Street 1:650 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3046
Practice Address - Country:US
Practice Address - Phone:203-573-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR5471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics