Provider Demographics
NPI:1346736352
Name:HART, JENNA LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LEE
Last Name:HART
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 1:13241 BARTRAM PARK BLVD UNIT 1601
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5222
Mailing Address - Country:US
Mailing Address - Phone:904-207-7700
Mailing Address - Fax:904-746-4286
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 1601
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5222
Practice Address - Country:US
Practice Address - Phone:904-207-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN235891223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice