Provider Demographics
NPI:1326921321
Name:KREID, JENNIFER R (RDH, PHDH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:KREID
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 CHAMNESS RD
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-3117
Mailing Address - Country:US
Mailing Address - Phone:618-319-0415
Mailing Address - Fax:
Practice Address - Street 1:1365 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2583
Practice Address - Country:US
Practice Address - Phone:618-319-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.011685124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist