Provider Demographics
NPI:1982087722
Name:WASELUES, JENNA KAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:KAYE
Last Name:WASELUES
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 1:245 W VAN ASCHE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4973
Mailing Address - Country:US
Mailing Address - Phone:479-442-4051
Mailing Address - Fax:479-442-5907
Practice Address - Street 1:245 W VAN ASCHE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4973
Practice Address - Country:US
Practice Address - Phone:479-442-4051
Practice Address - Fax:479-442-5907
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist