Healthcare Provider Details

I. General information

NPI: 1295726834
Provider Name (Legal Business Name): JAMES HARRIS JENNINGS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 21ST ST SUITE B
CLOVIS NM
88101-4492
US

IV. Provider business mailing address

PO BOX 1774
CLOVIS NM
88102-1774
US

V. Phone/Fax

Practice location:
  • Phone: 505-762-4794
  • Fax: 505-762-1529
Mailing address:
  • Phone: 505-762-4794
  • Fax: 505-762-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberNM1298
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: