Provider Demographics
NPI:1235464223
Name:RA, JENNIFER J (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:RA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 MERIDIAN ST.
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-676-1499
Mailing Address - Fax:360-738-2281
Practice Address - Street 1:2710 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-676-1499
Practice Address - Fax:360-738-2281
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03747122300000X
WADE60167264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist