Provider Demographics
NPI:1093959595
Name:CARCAUD-HENNIGAR, JENNIE P (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:P
Last Name:CARCAUD-HENNIGAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 WHITE MOUNTAIN HWY
Mailing Address - Street 2:DENTAL CENTER
Mailing Address - City:TAMWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03886-4626
Mailing Address - Country:US
Mailing Address - Phone:603-323-7645
Mailing Address - Fax:603-323-7647
Practice Address - Street 1:448 WHITE MOUNTAIN HWY
Practice Address - Street 2:DENTAL CENTER
Practice Address - City:TAMWORTH
Practice Address - State:NH
Practice Address - Zip Code:03886-4626
Practice Address - Country:US
Practice Address - Phone:603-323-7645
Practice Address - Fax:603-323-7647
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033111223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health