Provider Demographics
NPI:1457344343
Name:UHL, JENNIFER SUZANNE (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:UHL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 S PACIFIC ST
Mailing Address - Street 2:#4
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4949
Mailing Address - Country:US
Mailing Address - Phone:760-315-3096
Mailing Address - Fax:
Practice Address - Street 1:1ST DEN BN/ NDC
Practice Address - Street 2:13 AREA BUILDING # 13128
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-5578
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3665124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist