Provider Demographics
NPI:1407870470
Name:LOMBRANO, JENNIFER (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LOMBRANO
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 1:6436 SOUTHPOINTE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-6219
Mailing Address - Country:US
Mailing Address - Phone:907-331-8551
Mailing Address - Fax:
Practice Address - Street 1:4201 TUDOR CENTRE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-317-6070
Practice Address - Fax:806-794-5178
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK1081122300000X
AK1791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1411497OtherUNITED CONCORDIA
AKDD50522Medicaid