Provider Demographics
NPI:1316516966
Name:ZACHAREWICZ, JENNA (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:ZACHAREWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 NW 63RD PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4420
Mailing Address - Country:US
Mailing Address - Phone:954-415-1297
Mailing Address - Fax:
Practice Address - Street 1:1037 S STATE ROAD 7 STE 211
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6139
Practice Address - Country:US
Practice Address - Phone:954-415-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist