Provider Demographics
NPI:1437241817
Name:REDMORE, JENNIFER LONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LONG
Last Name:REDMORE
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:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748-0198
Mailing Address - Country:US
Mailing Address - Phone:607-722-5464
Mailing Address - Fax:607-754-9526
Practice Address - Street 1:703 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:NY
Practice Address - Zip Code:13748-0198
Practice Address - Country:US
Practice Address - Phone:607-722-5464
Practice Address - Fax:607-754-9526
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0474621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice