Healthcare Provider Details

I. General information

NPI: 1821929449
Provider Name (Legal Business Name): CLAUDIA JENNINGS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 BELLE WOOD DR
HENDERSON KY
42420-9141
US

IV. Provider business mailing address

981 BELLE WOOD DR
HENDERSON KY
42420-9141
US

V. Phone/Fax

Practice location:
  • Phone: 270-860-0915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD-00193
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: