Provider Demographics
NPI:1073554291
Name:HOLMER SU, JENNIFER ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:HOLMER SU
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 1:159 CROWN ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2764
Mailing Address - Country:US
Mailing Address - Phone:716-689-9159
Mailing Address - Fax:
Practice Address - Street 1:1950 SHERIDAN DR
Practice Address - Street 2:#5
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1240
Practice Address - Country:US
Practice Address - Phone:716-875-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049550-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist