Provider Demographics
NPI:1740590900
Name:MCLEOD, JENNIFER M (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3100
Mailing Address - Country:US
Mailing Address - Phone:503-538-7717
Mailing Address - Fax:
Practice Address - Street 1:615 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3100
Practice Address - Country:US
Practice Address - Phone:503-538-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist