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General NPI Number Information
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NPI Number | 1043370448
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Entity Type | Organization
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Legal Business Name | JENNIFER DATWYLER, DMD, INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 5009 WINDPLAY DR SUITE 1
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City | EL DORADO HILLS
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State | CA
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Zip | 95762
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Country | US
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Telephone | 916-941-2366
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Fax | 916-941-1443
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Provider Business Mailing Address
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Address Line | 5009 WINDPLAY DR SUITE 1
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City | EL DORADO HILLS
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State | CA
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Zip | 95762
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Country | US
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Telephone | 916-941-2341
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Fax | 916-941-1443
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER R DATWYLER
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Credential | DMD
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Telephone | 916-941-2341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 42679
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License Number State | CA
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