Provider Demographics
NPI:1003291527
Name:FICCO, JENNIFER (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:FICCO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 NW 132ND CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1607
Mailing Address - Country:US
Mailing Address - Phone:360-624-7729
Mailing Address - Fax:
Practice Address - Street 1:910 NE TENNEY RD
Practice Address - Street 2:SUITE 117
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2837
Practice Address - Country:US
Practice Address - Phone:360-695-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004393124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist