Provider Demographics
NPI:1225247497
Name:HADLEY-KUPFER, JENNIFER LYNN (RDA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:HADLEY-KUPFER
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:MACY
Mailing Address - State:NE
Mailing Address - Zip Code:68039-0250
Mailing Address - Country:US
Mailing Address - Phone:402-837-5381
Mailing Address - Fax:402-837-4424
Practice Address - Street 1:100 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039-0250
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:402-837-4424
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR07331126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant