Provider Demographics
NPI:1902542517
Name:OH, JENNIFER N (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:N
Last Name:OH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3311 YOAKUM TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5766
Mailing Address - Country:US
Mailing Address - Phone:260-710-5246
Mailing Address - Fax:
Practice Address - Street 1:306 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-4600
Practice Address - Country:US
Practice Address - Phone:210-455-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist