Provider Demographics
NPI:1568813590
Name:OUAZANA, JENNIFER FRIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FRIDA
Last Name:OUAZANA
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 1:4 SUDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4117
Mailing Address - Country:US
Mailing Address - Phone:410-602-8100
Mailing Address - Fax:410-602-8135
Practice Address - Street 1:4 SUDBROOK LN
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4117
Practice Address - Country:US
Practice Address - Phone:410-602-8100
Practice Address - Fax:410-602-8135
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist