Provider Demographics
NPI:1861003063
Name:FRANCIS, JENNIFER ANN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:CA
Mailing Address - Zip Code:92386-1047
Mailing Address - Country:US
Mailing Address - Phone:909-533-7234
Mailing Address - Fax:
Practice Address - Street 1:15301 TYLER FOOTE RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26628124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist