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General NPI Number Information
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NPI Number | 1891984522
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Entity Type | Organization
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Legal Business Name | JENNINGS DENTISTRY INC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 420 N WEST ST
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City | ODON
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State | IN
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Zip | 47562-1036
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Country | US
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Telephone | 812-636-4334
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Fax | 812-636-8325
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Provider Business Mailing Address
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Address Line | 420 N WEST ST
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City | ODON
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State | IN
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Zip | 47562-1036
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Country | US
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Telephone | 812-636-4334
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Fax | 812-636-8325
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHELLE LYNN JENNINGS
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Credential | DDS
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Telephone | 812-636-4334
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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 | 12010880A
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License Number State | IN
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