Provider Demographics
NPI:1891984522
Name:JENNINGS DENTISTRY INC
Entity Type:Organization
Organization Name:JENNINGS DENTISTRY INC
Other - Org Name:ODON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-636-4334
Mailing Address - Street 1:420 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-1036
Mailing Address - Country:US
Mailing Address - Phone:812-636-4334
Mailing Address - Fax:812-636-8325
Practice Address - Street 1:420 N WEST ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1036
Practice Address - Country:US
Practice Address - Phone:812-636-4334
Practice Address - Fax:812-636-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010880A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty