Provider Demographics
NPI:1659829596
Name:MCDERMOTT, JENNIFER MAE (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MAE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:34679 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-9307
Mailing Address - Country:US
Mailing Address - Phone:503-975-7833
Mailing Address - Fax:
Practice Address - Street 1:34679 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-9307
Practice Address - Country:US
Practice Address - Phone:503-975-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4651124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist