Provider Demographics
NPI:1932380243
Name:VIGNERON, JENNA T (DDS)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:T
Last Name:VIGNERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:T
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1602 RUTHERFORD CT SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-8918
Mailing Address - Country:US
Mailing Address - Phone:319-541-0109
Mailing Address - Fax:
Practice Address - Street 1:2409 SE DELAWARE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4568
Practice Address - Country:US
Practice Address - Phone:515-505-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist