Provider Demographics
NPI:1629578893
Name:MCCRORY, JENNIFER (RDH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12333 E 2ND DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8337
Mailing Address - Country:US
Mailing Address - Phone:303-478-2133
Mailing Address - Fax:
Practice Address - Street 1:12333 E 2ND DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8337
Practice Address - Country:US
Practice Address - Phone:303-478-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLOCAL.0001364124Q00000X
CODH.002025002124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist