Provider Demographics
NPI:1386827202
Name:INTRACHAT, JENETTE D (DDS)
Entity Type:Individual
Prefix:
First Name:JENETTE
Middle Name:D
Last Name:INTRACHAT
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 1:357 S GULPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3136
Mailing Address - Country:US
Mailing Address - Phone:610-337-2325
Mailing Address - Fax:610-337-3863
Practice Address - Street 1:357 S GULPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3136
Practice Address - Country:US
Practice Address - Phone:610-337-2325
Practice Address - Fax:610-337-2325
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00011067OtherLICENSE NUMBER
WAFI0401997OtherDEA