Provider Demographics
NPI:1841791118
Name:REICHERT, JENNIFER (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REICHERT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RUFFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S FLORIDA AVE STE 6
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5237
Practice Address - Country:US
Practice Address - Phone:863-688-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH16200124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist