Provider Demographics
NPI:1861500282
Name:JENNINGS, BRAD LAMAR (DDS MDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:LAMAR
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14441 MEMORIAL DR
Mailing Address - Street 2:#24
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:281-497-7920
Mailing Address - Fax:281-497-7971
Practice Address - Street 1:14441 MEMORIAL DR
Practice Address - Street 2:#24
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:281-497-7920
Practice Address - Fax:281-497-7971
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics