Individual
JENNA DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(847) 688-1900
Mailing address
2839 W GLEN FLORA AVE APT 6305, WAUKEGAN, IL 60085-1393
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS041960
PA
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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