Provider Demographics
NPI:1578903746
Name:NEIMAN, JENNIFER NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:NEIMAN
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 1:375 MUNICIPAL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3543
Mailing Address - Country:US
Mailing Address - Phone:972-669-3663
Mailing Address - Fax:
Practice Address - Street 1:375 MUNICIPAL DR. 104
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TN
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-669-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist