MEDICARE: JENNA HERR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22DI03052000	NJ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS043238	PA

General Provider Information

NPI Number	:	1679362891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA HERR

Provider Business Mailing Address
First Line	:	322 S 15TH ST APT 3F
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4910
Country	:	US
Telephone Number	:	518-944-4481
Fax Number	:

Provider Business Practice Location Address
First Line	:	1352 SOUTH ST # C3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1858
Country	:	US
Telephone Number	:	149-521-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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Directions to “ JENNA HERR ” Practice Location

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