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General NPI Number Information
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NPI Number | 1508785270
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Entity Type | Individual
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Provider Name | JENNIFER R HAVENS DMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 1328 N STANFORD LN
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-5034
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Country | US
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Telephone | 509-891-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 15521 N CUSTER CT
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City | MEAD
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State | WA
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Zip | 99021-9018
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Country | US
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Telephone | 509-720-9086
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DENT.DE.70147522
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License Number State | WA
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