Provider Demographics
NPI:1215591839
Name:BREHOVE, JENNIFER (DMD, MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BREHOVE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 CALLE LAS MORAS
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4165
Mailing Address - Country:US
Mailing Address - Phone:760-420-2441
Mailing Address - Fax:
Practice Address - Street 1:2226 OTAY LAKES RD STE AANDB
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1010
Practice Address - Country:US
Practice Address - Phone:619-336-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD115351223X0400X
CADDS1055501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics