Provider Demographics
NPI:1255198107
Name:TOPA, JENNA M
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:TOPA
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 1:169 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-3603
Mailing Address - Country:US
Mailing Address - Phone:570-491-0126
Mailing Address - Fax:
Practice Address - Street 1:1000 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:MADISON TWP
Practice Address - State:PA
Practice Address - Zip Code:18444-7013
Practice Address - Country:US
Practice Address - Phone:570-780-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH075505124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist