Doctor Name: | DR. JENNIFER LYNN UDIS |
NPI Number: | 1205985009 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.M.D |
License Number: | DS036161 |
Business Practice Address: | 716 Bethlehem Pike Erdenheim, PA - 190388102 |
Business Phone Number: | 2152330206 |
Business Fax Number: | |
Mailing Address: | 233 S 6th St Apt 1412, PHILADELPHIA |
State: | PA |
Postal Code: | 191063754 |
Phone Number: | 2152668998 |
Fax Number: | |
NPI Enumeration Date: | 01/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | DS036161 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |