MEDICARE: DR. CHARLES MICHAEL JENNESS DDS

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	1223G0001X	General Practice Dentistry	7426	MN

General Provider Information

NPI Number	:	1952358236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL JENNESS DDS

Provider Business Mailing Address
First Line	:	CMR 402
Second Line	:	LANDSTHUL DENTAL ACTIVITY CREDENTIALS OFFICE
City	:	APO AE
State	:	NY
Zip	:	09180
Country	:	US
Telephone Number	:	637-192-9130
Fax Number	:

Provider Business Practice Location Address
First Line	:	CMR 402
Second Line	:	LANDSTHUL DENTAL ACTIVITY CREDENTIALS OFFICE
City	:	APO AE
State	:	NY
Zip	:	09180
Country	:	US
Telephone Number	:	637-192-9130
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/08/2007

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