Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D4544 | AZ |
NPI | 1083735211 |
---|---|
Provider Name | James Allen Jennings |
First Address | Casa Grande, AZ 85222-2226 |
Second Address | Casa Grande, AZ 85222-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |