Provider Demographics
NPI:1790881225
Name:WOOLEY, JEANNINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:
Last Name:WOOLEY
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 1:795 RT 70 EAST
Mailing Address - Street 2:STE O
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-797-8600
Mailing Address - Fax:856-797-8699
Practice Address - Street 1:795 RT 70 EAST
Practice Address - Street 2:STE O
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-797-8600
Practice Address - Fax:856-797-8699
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist