Provider Demographics
NPI:1073630372
Name:JENNINGS, ADRIENNE DOUGLAS (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:DOUGLAS
Last Name:JENNINGS
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 1:3600 E MCKINNEY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209
Mailing Address - Country:US
Mailing Address - Phone:855-697-6453
Mailing Address - Fax:855-731-5147
Practice Address - Street 1:3600 E MCKINNEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209
Practice Address - Country:US
Practice Address - Phone:855-697-6453
Practice Address - Fax:855-731-5147
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26374122300000X
IA084541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice