Provider Demographics
NPI:1760782031
Name:ALBERTUS, JENNIFER S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:ALBERTUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 DREXEL AVE
Mailing Address - Street 2:BASEMENT DENTAL OFFICE
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3325
Mailing Address - Country:US
Mailing Address - Phone:610-449-5055
Mailing Address - Fax:610-449-9845
Practice Address - Street 1:1231 DREXEL AVE
Practice Address - Street 2:BASEMENT DENTAL OFFICE
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3325
Practice Address - Country:US
Practice Address - Phone:610-449-5055
Practice Address - Fax:610-449-9845
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist