Provider Demographics
NPI:1396975611
Name:YARBOROUGH, JENNA ANN (DDS)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:YARBOROUGH
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 1:373 LOS CERROS DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1122
Mailing Address - Country:US
Mailing Address - Phone:415-717-8699
Mailing Address - Fax:
Practice Address - Street 1:8040 E INDIAN SCHOOL RD
Practice Address - Street 2:#110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2685
Practice Address - Country:US
Practice Address - Phone:888-238-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist