Provider Demographics
NPI:1679212542
Name:DINH, JENNIFER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DINH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:DINH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:15928 SARNO LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6255
Mailing Address - Country:US
Mailing Address - Phone:405-200-9401
Mailing Address - Fax:
Practice Address - Street 1:427 W DOOLIN AVE
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-1602
Practice Address - Country:US
Practice Address - Phone:580-670-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer