Provider Demographics
NPI:1477993731
Name:JENNINGS, MEGHAN RUTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:RUTH
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 N PROSPECT AVE
Mailing Address - Street 2:APT 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3020
Mailing Address - Country:US
Mailing Address - Phone:309-202-1184
Mailing Address - Fax:
Practice Address - Street 1:1260 N PROSPECT AVE
Practice Address - Street 2:APT 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3020
Practice Address - Country:US
Practice Address - Phone:309-202-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7096-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist