Andrea Jennings, DMD
Individual provider Active NPI Dentist · Dillon, CO
NPI 1013395185 · NPPES record last updated Jun 22, 2020
Key facts
- NPI
- 1013395185
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 30-24805 (OH)
- Practice address
- 119 Main St.
Dillon, CO 80435 - Phone
- (970) 468-2471
- NPI assigned
- May 11, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-24805 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Dental, PLLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 30-24805 | OH | Yes |
Addresses
Primary practice location
119 Main St.
Dillon, CO 80435
Mailing address
PO Box 158
Dillon, CO 80435-0158
Other providers in Dillon, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.