Provider Demographics
NPI:1104025808
Name:JENNINGS, DWIGHT ERWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:ERWIN
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 1:2187 HARBOR BAY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-3019
Mailing Address - Country:US
Mailing Address - Phone:510-522-6828
Mailing Address - Fax:510-522-0877
Practice Address - Street 1:2187 HARBOR BAY PARKWAY
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-3019
Practice Address - Country:US
Practice Address - Phone:510-522-6828
Practice Address - Fax:510-522-0877
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist