Provider Demographics
NPI:1154333631
Name:OCHOA, JENNIFER MARIE (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:OCHOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 VILLAGE DR
Mailing Address - Street 2:STE. B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5506
Mailing Address - Country:US
Mailing Address - Phone:210-654-6882
Mailing Address - Fax:210-654-0036
Practice Address - Street 1:8606 VILLAGE DR
Practice Address - Street 2:STE. B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5506
Practice Address - Country:US
Practice Address - Phone:210-654-6882
Practice Address - Fax:210-654-0036
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1798480-03Medicare ID - Type Unspecified
TX1798480-02Medicare ID - Type Unspecified