Provider Demographics
NPI:1861668634
Name:MEDINA, JENNIFER BOYAJIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BOYAJIAN
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:BOYAJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:235 PERUVIAN AVE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4695
Mailing Address - Country:US
Mailing Address - Phone:561-802-4424
Mailing Address - Fax:561-802-4494
Practice Address - Street 1:235 PERUVIAN AVE
Practice Address - Street 2:
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4695
Practice Address - Country:US
Practice Address - Phone:561-802-4424
Practice Address - Fax:561-802-4494
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 179991223G0001X
FLDH 15990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist