Provider Demographics
NPI:1306285119
Name:POWELL, JENNETH E (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNETH
Middle Name:E
Last Name:POWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4435 E HOLMES AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3372
Mailing Address - Country:US
Mailing Address - Phone:480-889-9457
Mailing Address - Fax:480-696-5505
Practice Address - Street 1:6120 W BELL RD
Practice Address - Street 2:STE 180
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3781
Practice Address - Country:US
Practice Address - Phone:602-298-7200
Practice Address - Fax:602-298-7202
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0087281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice