Provider Demographics
NPI:1669438321
Name:JARRETT, GLENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENNIS
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GLENNIS
Other - Middle Name:
Other - Last Name:PAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:76 NEALY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2022
Mailing Address - Country:US
Mailing Address - Phone:757-764-6824
Mailing Address - Fax:
Practice Address - Street 1:76 NEALY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2022
Practice Address - Country:US
Practice Address - Phone:757-764-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0185791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6076505Medicaid