Provider Demographics
NPI:1083710644
Name:TAUBE, JENNIFER ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:TAUBE
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 1:320 N MERIDIAN ST
Mailing Address - Street 2:SUITE 808
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1719
Mailing Address - Country:US
Mailing Address - Phone:317-632-6201
Mailing Address - Fax:
Practice Address - Street 1:320 N MERIDIAN ST
Practice Address - Street 2:SUITE 808
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1719
Practice Address - Country:US
Practice Address - Phone:317-632-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120080411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice