Provider Demographics
NPI:1669769071
Name:MCCLANAHAN, JENNIFER ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELAINE
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 MAE ANNE AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4736
Mailing Address - Country:US
Mailing Address - Phone:775-787-2600
Mailing Address - Fax:775-787-2602
Practice Address - Street 1:6350 MAE ANNE AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-4736
Practice Address - Country:US
Practice Address - Phone:775-787-2600
Practice Address - Fax:775-787-2602
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist