Provider Demographics
NPI:1699407288
Name:FENNELL, PATRICIA JEAN (RDH)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JEAN
Last Name:FENNELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:PATTIE
Other - Middle Name:JEAN
Other - Last Name:FENNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 E UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6821
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist