Provider Demographics
NPI:1750732269
Name:VRIKKIS, JENNIFER LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:VRIKKIS
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 1:3244 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3040
Mailing Address - Country:US
Mailing Address - Phone:336-922-2542
Mailing Address - Fax:336-922-1547
Practice Address - Street 1:3244 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3040
Practice Address - Country:US
Practice Address - Phone:336-922-2542
Practice Address - Fax:336-922-1547
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist