Provider Demographics
NPI:1508929688
Name:MILAZZO, JENNIFER R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 S UNIVERSITY BOULEVARD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3045
Mailing Address - Country:US
Mailing Address - Phone:251-342-2324
Mailing Address - Fax:251-342-2405
Practice Address - Street 1:120 S UNIVERSITY BOULEVARD
Practice Address - Street 2:SUITE C1
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3045
Practice Address - Country:US
Practice Address - Phone:251-342-2324
Practice Address - Fax:251-342-2405
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice