Individual
DR. JENNIFER A SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
7073 S STATE ROAD 67, PENDLETON, IN 46064-9079
(765) 778-2176
Mailing address
7073 S STATE ROAD 67, PENDLETON, IN 46064-9079
(765) 778-2176
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011968A
IN
Other
Enumeration date
06/04/2013
Last updated
10/25/2016
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