Provider Demographics
NPI:1306041413
Name:DECHAINE, JENNIFER LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DECHAINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:DECHAINE-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:400 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1865
Mailing Address - Country:US
Mailing Address - Phone:763-389-3126
Mailing Address - Fax:763-389-3194
Practice Address - Street 1:165 19TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2153
Practice Address - Country:US
Practice Address - Phone:320-253-9270
Practice Address - Fax:320-255-5413
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice