Provider Demographics
NPI:1356561047
Name:JENNINGS, VALERIE (DDS)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:JENNINGS
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 1:4624 PROGRESS DR.
Mailing Address - Street 2:SUITE E
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-355-1251
Mailing Address - Fax:
Practice Address - Street 1:4624 PROGRESS DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3490
Practice Address - Country:US
Practice Address - Phone:563-355-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist