Provider Demographics
NPI:1376736041
Name:BENCH, JENNIFER (RDH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BENCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SCHENK PL
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1145
Mailing Address - Country:US
Mailing Address - Phone:609-223-0179
Mailing Address - Fax:
Practice Address - Street 1:305TH DENTAL SQUADRON
Practice Address - Street 2:BLDG. 2417 MCGUIRE BLVD.
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00494800124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist