Provider Demographics
NPI:1033557293
Name:EZEH, JENNIFER C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:EZEH
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:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-454-3025
Mailing Address - Fax:903-450-1408
Practice Address - Street 1:3600 CADDO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4511
Practice Address - Country:US
Practice Address - Phone:903-454-6965
Practice Address - Fax:903-454-7981
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice