MEDICARE: MRS. JENNIFER MARIE CAREY RDH

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	124Q00000X	Dental Hygienist	H5757	MN
2	125J00000X	Dental Therapist	DT67	MN

General Provider Information

NPI Number	:	1831553312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE CAREY RDH

Provider Business Mailing Address
First Line	:	3552 190TH AVE NE
Second Line	:
City	:	WYOMING
State	:	MN
Zip	:	55092-9527
Country	:	US
Telephone Number	:	763-301-0322
Fax Number	:

Provider Business Practice Location Address
First Line	:	10756 BUTTERNUT ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-4448
Country	:	US
Telephone Number	:	763-757-4170
Fax Number	:

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	06/06/2016

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