Provider Demographics
NPI:1467208306
Name:TITTLE, JENAL LOUISE (RDH)
Entity type:Individual
Prefix:
First Name:JENAL
Middle Name:LOUISE
Last Name:TITTLE
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 1:95-1053 HALOKU ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4979
Mailing Address - Country:US
Mailing Address - Phone:808-226-3924
Mailing Address - Fax:
Practice Address - Street 1:95-1053 HALOKU ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4979
Practice Address - Country:US
Practice Address - Phone:808-226-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDH-1050124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist