Provider Demographics
NPI:1508259151
Name:WILBER, JENNIFER CARR (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CARR
Last Name:WILBER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LEVESQUE DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903
Mailing Address - Country:US
Mailing Address - Phone:207-439-0779
Mailing Address - Fax:207-439-0883
Practice Address - Street 1:17 LEVESQUE DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903
Practice Address - Country:US
Practice Address - Phone:207-439-0779
Practice Address - Fax:207-439-0883
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1547124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist