Provider Demographics
NPI:1861684698
Name:MCGUIRE HAVEMAN, JENNIFER L (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:MCGUIRE HAVEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:NAVAL HEALTH CLINIC QUANTICO
Mailing Address - Street 2:3259 CATLIN AVE
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134
Mailing Address - Country:US
Mailing Address - Phone:703-784-2802
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC QUANTICO
Practice Address - Street 2:3259 CATLIN AVE
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134
Practice Address - Country:US
Practice Address - Phone:703-784-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21875122300000X
MADN218751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist