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General NPI Number Information
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NPI Number | 1396740023
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Entity Type | Individual
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Provider Name | DAVID R JENNINGS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 324 W SUPERIOR ST STE 720
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City | DULUTH
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State | MN
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Zip | 55802-1721
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Country | US
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Telephone | 218-727-8994
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Fax | 218-727-8995
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Provider Business Mailing Address
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Address Line | 324 W SUPERIOR ST STE 720
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City | DULUTH
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State | MN
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Zip | 55802-1721
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Country | US
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Telephone | 218-727-8994
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Fax | 218-727-8995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8761
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4374015
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00006557
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License Number State | WA
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