Provider Demographics
NPI:1255627592
Name:LO, JENNIFER (DDS, MPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 LOS PALOS DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3916
Mailing Address - Country:US
Mailing Address - Phone:831-272-2688
Mailing Address - Fax:831-785-2968
Practice Address - Street 1:1045 LOS PALOS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3916
Practice Address - Country:US
Practice Address - Phone:831-272-2688
Practice Address - Fax:831-785-2968
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry