Provider Demographics
NPI:1386795185
Name:ECKMANN, JENNIFER JO (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JO
Last Name:ECKMANN
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-0245
Mailing Address - Country:US
Mailing Address - Phone:320-243-4434
Mailing Address - Fax:
Practice Address - Street 1:106 E JAMES ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1615
Practice Address - Country:US
Practice Address - Phone:320-243-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist