Provider Demographics
NPI:1043370448
Name:JENNIFER DATWYLER, DMD, INC
Entity Type:Organization
Organization Name:JENNIFER DATWYLER, DMD, INC
Other - Org Name:MAGIC SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DATWYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-941-2341
Mailing Address - Street 1:5009 WINDPLAY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-941-2341
Mailing Address - Fax:916-941-1443
Practice Address - Street 1:5009 WINDPLAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-941-2366
Practice Address - Fax:916-941-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty