Provider Demographics
NPI:1568132041
Name:ECKENRODE, JENNA JADE (RDH)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:JADE
Last Name:ECKENRODE
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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:17502-0176
Mailing Address - Country:US
Mailing Address - Phone:610-457-0659
Mailing Address - Fax:
Practice Address - Street 1:101 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5108
Practice Address - Country:US
Practice Address - Phone:717-450-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist