Healthcare Provider Details

I. General information

NPI: 1114488772
Provider Name (Legal Business Name): JENNIFER CAUGHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S STATE ST
DOVER DE
19901-6901
US

IV. Provider business mailing address

21006 WAVECREST TER
LEWES DE
19958-1908
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4450
  • Fax:
Mailing address:
  • Phone: 152-688-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG1-0011626
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: