Provider Demographics
NPI:1811643984
Name:JENDI, AREEGE
Entity type:Individual
Prefix:
First Name:AREEGE
Middle Name:
Last Name:JENDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 GOLDSMITH LN UNIT 16
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2096
Mailing Address - Country:US
Mailing Address - Phone:973-420-0264
Mailing Address - Fax:
Practice Address - Street 1:1986 WALTON NICHOLSON PIKE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7906
Practice Address - Country:US
Practice Address - Phone:859-356-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-26
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY108131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program