Provider Demographics
NPI:1316292873
Name:HOLE, JENNIFER CECILE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CECILE
Last Name:HOLE
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 1:109 E AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-2347
Mailing Address - Country:US
Mailing Address - Phone:361-387-1531
Mailing Address - Fax:361-767-8802
Practice Address - Street 1:109 E AVENUE J
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-2347
Practice Address - Country:US
Practice Address - Phone:361-387-1531
Practice Address - Fax:361-767-8802
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD52281223G0001X
TX280521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice