Provider Demographics
NPI:1952417768
Name:EISENHUTH, JENNIFER L (DDS, MS, PA)
Entity Type:Individual
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First Name:JENNIFER
Middle Name:L
Last Name:EISENHUTH
Suffix:
Gender:F
Credentials:DDS, MS, PA
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3340 SHERMAN CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-5000
Mailing Address - Country:US
Mailing Address - Phone:651-406-8100
Mailing Address - Fax:651-406-8060
Practice Address - Street 1:3340 SHERMAN CT
Practice Address - Street 2:SUITE 200
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5000
Practice Address - Country:US
Practice Address - Phone:651-406-8100
Practice Address - Fax:651-406-8060
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN108741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics