Healthcare Provider Details

I. General information

NPI: 1609211788
Provider Name (Legal Business Name): JENNIFER FERNANDEZ LITTON DMD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 VICENTE ST
SAN FRANCISCO CA
94116-2832
US

IV. Provider business mailing address

101 S LAKE MERCED HILL
SAN FRANCISCO CA
94132
US

V. Phone/Fax

Practice location:
  • Phone: 415-566-6900
  • Fax:
Mailing address:
  • Phone: 774-329-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number36578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: