Provider Demographics
NPI:1558341925
Name:THARP, JENNIFER SCHULTZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SCHULTZ
Last Name:THARP
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 1:12385 BEDELL DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-9461
Mailing Address - Country:US
Mailing Address - Phone:850-529-4738
Mailing Address - Fax:
Practice Address - Street 1:12385 BEDELL DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-9461
Practice Address - Country:US
Practice Address - Phone:850-529-4738
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001629351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice