Provider Demographics
NPI:1174057525
Name:LAUREL, JENNIFER (CRDH)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LAUREL
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37944 PASCO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4202
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:
Practice Address - Street 1:37944 PASCO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4202
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH23935124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist