Provider Demographics
NPI:1164669958
Name:MAVES, JENNY LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LYNN
Last Name:MAVES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8844 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-9054
Mailing Address - Country:US
Mailing Address - Phone:715-824-2175
Mailing Address - Fax:
Practice Address - Street 1:3216 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-8838
Practice Address - Country:US
Practice Address - Phone:715-346-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI599416124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist