Provider Demographics
NPI:1801025614
Name:GERIC, JENNIFER HARGRAVE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HARGRAVE
Last Name:GERIC
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 1:100 WHETSTONE PL
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5774
Mailing Address - Country:US
Mailing Address - Phone:904-810-2345
Mailing Address - Fax:904-810-5334
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:SUITE 308
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-810-2345
Practice Address - Fax:904-810-5334
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist