Provider Demographics
NPI:1770996084
Name:WILBOURN, JENNIFER CHADD (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHADD
Last Name:WILBOURN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ASTRID
Other - Last Name:CHADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2642 NW 66TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4908
Mailing Address - Country:US
Mailing Address - Phone:918-557-9369
Mailing Address - Fax:
Practice Address - Street 1:500 N FINANCIAL CENTER TERRACE
Practice Address - Street 2:SUITE D
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064
Practice Address - Country:US
Practice Address - Phone:405-376-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist