Provider Demographics
NPI:1154450567
Name:HAVEL, JENNIFER ANN (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HAVEL
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 1:915 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4947
Mailing Address - Country:US
Mailing Address - Phone:715-848-3241
Mailing Address - Fax:
Practice Address - Street 1:1101 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3505
Practice Address - Country:US
Practice Address - Phone:715-848-3241
Practice Address - Fax:715-848-3247
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice