Provider Demographics
NPI:1407102577
Name:TOFT, JENELLE MARIE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:MARIE
Last Name:TOFT
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 1:909 E COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2064
Mailing Address - Country:US
Mailing Address - Phone:307-234-6671
Mailing Address - Fax:307-237-6061
Practice Address - Street 1:909 E COLLINS DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2064
Practice Address - Country:US
Practice Address - Phone:307-234-6671
Practice Address - Fax:307-237-6061
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist