Provider Demographics
NPI:1073893137
Name:BICK, JENNETTE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNETTE
Middle Name:MARIE
Last Name:BICK
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 1:9225 DOERR RD BLDG 1220
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-2204
Mailing Address - Country:US
Mailing Address - Phone:571-231-6002
Mailing Address - Fax:
Practice Address - Street 1:BLDG 38801 ACADEMIC DRIVE
Practice Address - Street 2:SUITE B & C
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014131961223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics