Provider Demographics
NPI:1699078527
Name:PINERO, JENNIFER ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROSE
Last Name:PINERO
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 1:801 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3090
Mailing Address - Country:US
Mailing Address - Phone:267-296-1010
Mailing Address - Fax:267-296-1012
Practice Address - Street 1:801 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3090
Practice Address - Country:US
Practice Address - Phone:267-296-1010
Practice Address - Fax:267-296-1012
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00014291223P0221X
PADS0385431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1699078527Medicaid
DE250534643Medicaid