Provider Demographics
NPI:1144359720
Name:WYNN, JENNIFER H (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:WYNN
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 1:10697 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2680
Mailing Address - Country:US
Mailing Address - Phone:831-235-1003
Mailing Address - Fax:
Practice Address - Street 1:10697 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2680
Practice Address - Country:US
Practice Address - Phone:831-235-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394561223G0001X
AZD0096241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice