Provider Demographics
NPI:1124341698
Name:PRICE, JENALIE ROSE (RDH)
Entity type:Individual
Prefix:MRS
First Name:JENALIE
Middle Name:ROSE
Last Name:PRICE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:JENALIE
Other - Middle Name:ROSE
Other - Last Name:MARTINIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:01149637-192-9130
Mailing Address - Fax:01149637-192-9117
Practice Address - Street 1:LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:01149637-192-9130
Practice Address - Fax:01149637-192-9117
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH6635124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist