Provider Demographics
NPI:1821386616
Name:SMITH, JENNIFER LYNAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNAE
Other - Last Name:GOTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5708 SUNNYBROOK DR.
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106
Mailing Address - Country:US
Mailing Address - Phone:712-224-4001
Mailing Address - Fax:712-224-4004
Practice Address - Street 1:5708 SUNNYBROOK DR.
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106
Practice Address - Country:US
Practice Address - Phone:712-224-4001
Practice Address - Fax:712-224-4004
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA87731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice