Provider Demographics
NPI:1003223660
Name:GAW, JENNA (DDS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 LOCUST PL APT 303
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4239
Mailing Address - Country:US
Mailing Address - Phone:925-285-2411
Mailing Address - Fax:
Practice Address - Street 1:808 E WOODFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4836
Practice Address - Country:US
Practice Address - Phone:925-285-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4391122300000X
390200000X
OH004031390200000X
IL190324971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program