Healthcare Provider Details

I. General information

NPI: 1932380243
Provider Name (Legal Business Name): JENNA T VIGNERON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA T MILLER DDS

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 SE DELAWARE AVE STE 100
ANKENY IA
50021-4568
US

IV. Provider business mailing address

1602 RUTHERFORD CT SW
ALTOONA IA
50009-8918
US

V. Phone/Fax

Practice location:
  • Phone: 515-505-3378
  • Fax:
Mailing address:
  • Phone: 319-541-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08791
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: