Jennifer L Full, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS-09585 Issued in IA

Practice address

Boak Dental Clinic
12720 Kansas Ave BLDG 789
Fort Leonard Wood, MO 65473-6547

Phone

(706) 718-4719

NPI assigned

Aug 7, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jennifer L Solberg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1609355148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "US ARMY DENTAL ACTIVITY",
            "address_2": "6958 NEBRASKA AVE BUILDING 1608",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "65473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BOAK DENTAL CLINIC",
            "address_2": "12720 KANSAS AVE BLDG 789",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654736547",
            "telephone_number": "706-718-4719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULL",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-07",
        "last_updated": "2021-03-18",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "DDS-09585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SOLBERG",
            "middle_name": "L",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Teresa Freymiller, RN
• John Thomas Friedland, M.D.
• Heather Danielle Friend, APRN, FNP
• Ft Leonard Wood Wtu
• Sean Fulford
• Gustavo Garnica, MSW
• Anne-Laure Marie Genevieve Gatin
• Jaya Gayle, ACAT
• General Leonard Wood Army Community Hospital
• General Leonard Wood Army Community Hospital

• General Practice Dentistry in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.