Provider Demographics
NPI:1548579014
Name:EBNET, JANA LEE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LEE
Last Name:EBNET
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 1:903 W CENTER ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-6278
Mailing Address - Country:US
Mailing Address - Phone:507-529-0436
Mailing Address - Fax:507-529-0435
Practice Address - Street 1:903 W CENTER ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-6278
Practice Address - Country:US
Practice Address - Phone:507-529-0436
Practice Address - Fax:507-529-0435
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH4468124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist