Provider Demographics
NPI:1992475966
Name:IMANI, JENNIFER YVONNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YVONNE
Last Name:IMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 SKYVIEW COVE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-5800
Mailing Address - Country:US
Mailing Address - Phone:832-488-7572
Mailing Address - Fax:
Practice Address - Street 1:19620 KUYKENDAHL RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3457
Practice Address - Country:US
Practice Address - Phone:281-247-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist