Provider Demographics
NPI:1861572661
Name:JENNINGS, RICHARD ERNEST (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERNEST
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 NORTH FIRST STREET
Mailing Address - Street 2:SUTIE 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-435-4020
Mailing Address - Fax:559-435-5571
Practice Address - Street 1:6700 N 1ST ST
Practice Address - Street 2:SUTIE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3900
Practice Address - Country:US
Practice Address - Phone:559-435-4020
Practice Address - Fax:559-435-5571
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice