Provider Demographics
NPI:1174689319
Name:KETCHEL, JENNIFER P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:P
Last Name:KETCHEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PETTIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7410 S. COOPER STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLONGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001
Mailing Address - Country:US
Mailing Address - Phone:817-465-0044
Mailing Address - Fax:817-465-0055
Practice Address - Street 1:7410 S. COOPER STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLONGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-465-0044
Practice Address - Fax:817-465-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202741223P0221X
IL019.0266891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry