Provider Demographics
NPI:1356563761
Name:GARLAND, JENNIFER S (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:GARLAND
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 1:3115 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3099
Mailing Address - Country:US
Mailing Address - Phone:847-746-1115
Mailing Address - Fax:847-746-2515
Practice Address - Street 1:3115 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-3099
Practice Address - Country:US
Practice Address - Phone:847-746-1115
Practice Address - Fax:847-746-2515
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019O219481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice