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General NPI Number Information
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NPI Number | 1942723523
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Entity Type | Individual
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Provider Name | JAHNE BRISTOW
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 18947 JOHN J WILLIAMS HWY UNIT 301
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4477
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Country | US
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Telephone | 302-645-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 108 LAKESIDE DR
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City | LEWES
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State | DE
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Zip | 19958-8925
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Country | US
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Telephone | 845-546-1550
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10421
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD4955
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS044000
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0011583
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License Number State | DE
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