Provider Demographics
NPI:1952493066
Name:BAYER, JENNIFER M (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:BAYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12005 N TATUM BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1650
Mailing Address - Country:US
Mailing Address - Phone:602-971-0026
Mailing Address - Fax:602-971-2069
Practice Address - Street 1:12005 N TATUM BLVD
Practice Address - Street 2:STE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1650
Practice Address - Country:US
Practice Address - Phone:602-971-0026
Practice Address - Fax:602-971-2069
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist