Provider Demographics
NPI:1295327179
Name:HADRA, JENNIFER (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:HADRA
Suffix:
Gender:F
Credentials:DMD, MS
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 2480
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954
Mailing Address - Country:US
Mailing Address - Phone:252-216-2998
Mailing Address - Fax:252-338-8184
Practice Address - Street 1:SHORELINE ORTHODONTICS
Practice Address - Street 2:216 US-64
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954
Practice Address - Country:US
Practice Address - Phone:252-216-2998
Practice Address - Fax:252-338-8184
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120641223X0400X
VA04014172211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics