Provider Demographics
NPI:1851077432
Name:MAGUIRE, JENNIFER KATE (BDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TEXAS A&M SCHOOL OF DENTISTRY, PEDIATRIC DEPARTMENT
Mailing Address - Street 2:3302 GASTON AVENUE
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-828-8100
Mailing Address - Fax:
Practice Address - Street 1:TEXAS A&M
Practice Address - Street 2:3302 GASTON AVENUE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-828-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program