Provider Demographics
NPI:1417240078
Name:MOHR, JENNIFER ANDREYKA (DDS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANDREYKA
Last Name:MOHR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:SUSAN
Other - Last Name:ANDREYKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 N WILMOT ROAD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-290-8900
Mailing Address - Fax:520-290-8902
Practice Address - Street 1:1101 N WILMOT ROAD
Practice Address - Street 2:SUITE 213
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-290-8900
Practice Address - Fax:520-290-8902
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0081040122300000X
CA60283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist