Provider Demographics
NPI:1083181861
Name:STEWART, JENNA KRISTINE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:KRISTINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 454 BOX 1641
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250-0017
Mailing Address - Country:US
Mailing Address - Phone:859-240-0566
Mailing Address - Fax:
Practice Address - Street 1:ANSBACH KLINIKUM ESCHERICHSTRASSE 1
Practice Address - Street 2:
Practice Address - City:ANSBACH
Practice Address - State:GERMANY
Practice Address - Zip Code:91522
Practice Address - Country:DE
Practice Address - Phone:859-240-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7195124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist