Individual
DR. EVA JENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
483 W. SEED FARM RD., SACATON, AZ 85147-0038
(602) 528-1200
(602) 528-1255
Mailing address
483 W. SEED FARM RD., GILA RIVER HEALTH CARE CORP/CRED, SACATON, AZ 85147-0038
(602) 528-1200
(602) 528-1255
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5430
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
736465
—
AZ
01
—
AZ0479090
BCBS PROVIDER NUMBER
AZ
Enumeration date
10/20/2006
Last updated
02/24/2012
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