Provider Demographics
NPI:1083735211
Name:JENNINGS, JAMES ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E COTTONWOOD LN STE 1
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-2226
Mailing Address - Country:US
Mailing Address - Phone:520-876-5431
Mailing Address - Fax:520-876-4875
Practice Address - Street 1:907 E COTTONWOOD LN STE 1
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2226
Practice Address - Country:US
Practice Address - Phone:520-876-5431
Practice Address - Fax:520-876-4875
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD45441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry