Provider Demographics
NPI:1245392232
Name:JUPIO, JENNIFER RACQUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RACQUEL
Last Name:JUPIO
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 1:7758 W TIDWELL RD
Mailing Address - Street 2:STE. #126
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5741
Mailing Address - Country:US
Mailing Address - Phone:713-690-2555
Mailing Address - Fax:713-690-2777
Practice Address - Street 1:7758 W TIDWELL RD
Practice Address - Street 2:STE. #126
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-5741
Practice Address - Country:US
Practice Address - Phone:713-690-2555
Practice Address - Fax:713-690-2777
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167823707Medicaid
TX1678237-06Medicaid