Individual
JENNA MARIE VANDEWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4500 N HIATUS RD STE 202, SUNRISE, FL 33351-7983
(866) 988-4504
Mailing address
4500 N HIATUS RD STE 202, SUNRISE, FL 33351-7983
(908) 616-5149
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25241
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2020
Last updated
07/01/2024
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