Provider Demographics
NPI:1184004319
Name:STOVER, JENNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:STOVER
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 1:2019 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-7541
Mailing Address - Country:US
Mailing Address - Phone:704-842-0120
Mailing Address - Fax:
Practice Address - Street 1:1367 E GARRISON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5144
Practice Address - Country:US
Practice Address - Phone:704-864-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist