Provider Demographics
NPI:1184688707
Name:LIVERMORE, JENNIFER D (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10567 SAWMILL PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065
Mailing Address - Country:US
Mailing Address - Phone:161-473-4950
Mailing Address - Fax:
Practice Address - Street 1:10567 SAWMILL PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6672
Practice Address - Country:US
Practice Address - Phone:161-473-4950
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist