Provider Demographics
NPI:1831284801
Name:JENNINGS, RONALD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
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 1:514 S NOLAND ROAD
Mailing Address - Street 2:NOLAND MEDICAL PLAZA SUITE 120
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050
Mailing Address - Country:US
Mailing Address - Phone:816-836-5520
Mailing Address - Fax:816-836-5043
Practice Address - Street 1:514 S NOLAND ROAD
Practice Address - Street 2:NOLAND MEDICAL PLAZA SUITE 120
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050
Practice Address - Country:US
Practice Address - Phone:816-836-5520
Practice Address - Fax:816-836-5043
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice