Provider Demographics
NPI:1861587396
Name:STERN, JENNIFER ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:STERN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MIELECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5355 FORT WARD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7114
Mailing Address - Country:US
Mailing Address - Phone:614-572-7228
Mailing Address - Fax:
Practice Address - Street 1:6649 N HIGH ST
Practice Address - Street 2:# B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-4070
Practice Address - Country:US
Practice Address - Phone:614-572-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist