Provider Demographics
NPI:1356355564
Name:HINSHAW, JENNIFER LEE (DMD, FAGD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:HINSHAW
Suffix:
Gender:F
Credentials:DMD, FAGD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:GREGORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, FAGD
Mailing Address - Street 1:4826 BREAKERS ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53597-8833
Mailing Address - Country:US
Mailing Address - Phone:774-254-4329
Mailing Address - Fax:
Practice Address - Street 1:1001 N GAMMON RD STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3874
Practice Address - Country:US
Practice Address - Phone:608-831-5151
Practice Address - Fax:608-831-3194
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21114122300000X
RIDEN03317122300000X
WI6001141-151223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice