Provider Demographics
NPI:1861533689
Name:RAWLINS, JENNIFER A (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:RAWLINS
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 1:201 SOUTH AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4812
Mailing Address - Country:US
Mailing Address - Phone:845-473-0683
Mailing Address - Fax:845-473-0684
Practice Address - Street 1:90 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4412
Practice Address - Country:US
Practice Address - Phone:845-473-0683
Practice Address - Fax:845-473-0684
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048084-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960732Medicaid
NY048084-1OtherLICENSE NO.
NY048084-1OtherLICENSE NO.