Provider Demographics
NPI:1366163057
Name:FRITTS, JENNIFER (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FRITTS
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 DERBY WAY DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4702
Mailing Address - Country:US
Mailing Address - Phone:314-650-7511
Mailing Address - Fax:
Practice Address - Street 1:5 HEALTH DEPARTMENT DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-4551
Practice Address - Country:US
Practice Address - Phone:636-528-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017124124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist