Provider Demographics
NPI:1174704860
Name:DUCHANE, JENNIFER RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENEE
Last Name:DUCHANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:DUCHANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1436 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1648
Mailing Address - Country:US
Mailing Address - Phone:812-232-7447
Mailing Address - Fax:812-232-6962
Practice Address - Street 1:1436 LOCUST ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1648
Practice Address - Country:US
Practice Address - Phone:812-232-7447
Practice Address - Fax:812-232-6962
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200169260AMedicaid