Provider Demographics
NPI:1972651602
Name:LEVER, JENNIFER WREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WREN
Last Name:LEVER
Suffix:
Gender:F
Credentials:DMD
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 1117
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-1117
Mailing Address - Country:US
Mailing Address - Phone:864-576-0870
Mailing Address - Fax:864-574-6628
Practice Address - Street 1:2001 E BLACKSTOCK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2734
Practice Address - Country:US
Practice Address - Phone:864-576-0870
Practice Address - Fax:864-574-6628
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice