Provider Demographics
NPI:1952324261
Name:ROSE, JENNIFER TRIDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TRIDER
Last Name:ROSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 PATTERSON AVE
Mailing Address - Street 2:STE C
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6755
Mailing Address - Country:US
Mailing Address - Phone:804-285-8290
Mailing Address - Fax:804-285-0733
Practice Address - Street 1:7110 PATTERSON AVE
Practice Address - Street 2:STE C
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-6755
Practice Address - Country:US
Practice Address - Phone:804-285-8290
Practice Address - Fax:804-285-0733
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice