Provider Demographics
NPI:1588926125
Name:LOSIER, JENNIFER CORONADO (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CORONADO
Last Name:LOSIER
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 1:4170 GRAPE ROAD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-272-4200
Mailing Address - Fax:
Practice Address - Street 1:720 E COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1220
Practice Address - Country:US
Practice Address - Phone:260-483-4000
Practice Address - Fax:260-444-4316
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011808A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist