Provider Demographics
NPI:1245364413
Name:BANQUER, JENNIFER L (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BANQUER
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 1:1708 MANHATTAN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3400
Mailing Address - Country:US
Mailing Address - Phone:504-361-5333
Mailing Address - Fax:
Practice Address - Street 1:1708 MANHATTAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3400
Practice Address - Country:US
Practice Address - Phone:504-361-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice