Healthcare Provider Details

I. General information

NPI: 1003230137
Provider Name (Legal Business Name): JANELLE JEHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4342 4TH AVE S
MINNEAPOLIS MN
55409-2155
US

IV. Provider business mailing address

636 BROADWAY ST NE
MINNEAPOLIS MN
55413-2164
US

V. Phone/Fax

Practice location:
  • Phone: 612-822-9030
  • Fax: 612-821-2818
Mailing address:
  • Phone: 612-746-1530
  • Fax: 612-746-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT38
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: