Provider Demographics
NPI:1124405857
Name:GAUGER, JENNA SUSANNE (ADT)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:SUSANNE
Last Name:GAUGER
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SOUTH 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265
Mailing Address - Country:US
Mailing Address - Phone:320-269-6406
Mailing Address - Fax:320-269-6408
Practice Address - Street 1:2100 11TH ST E
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-2625
Practice Address - Country:US
Practice Address - Phone:320-864-3129
Practice Address - Fax:320-269-6408
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT55125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist