Basic Information
| Provider Information | |||||||||
| NPI: | 1003017278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 704 BARRETT BLVD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424204931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708269887 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 704 BARRETT BLVD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424204931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708269887 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 657 | KY | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.