Provider Demographics
NPI:1932888948
Name:SICARD, JENNA LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LYNN
Last Name:SICARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05857
Mailing Address - Country:US
Mailing Address - Phone:802-673-4617
Mailing Address - Fax:
Practice Address - Street 1:52 GELO PARK RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:VT
Practice Address - Zip Code:05847-9796
Practice Address - Country:US
Practice Address - Phone:802-744-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT015.0134280124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist