Provider Demographics
NPI:1689774341
Name:JENNINGS, DENNIS EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EUGENE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E BENTON DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8688
Mailing Address - Country:US
Mailing Address - Phone:920-734-7487
Mailing Address - Fax:
Practice Address - Street 1:5553 WATERFORD LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8468
Practice Address - Country:US
Practice Address - Phone:920-739-7165
Practice Address - Fax:920-739-7361
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58060151223P0700X
TX120241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33792400Medicaid