Provider Demographics
NPI:1457787905
Name:SHEETS, JENNA CONSTANCE (RDH)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:CONSTANCE
Last Name:SHEETS
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 1:608 SIOUX ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5366
Mailing Address - Country:US
Mailing Address - Phone:517-812-8415
Mailing Address - Fax:
Practice Address - Street 1:608 SIOUX ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5366
Practice Address - Country:US
Practice Address - Phone:517-812-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016965124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist