Individual
JENNA MICHELE VANDENAVOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
018.002312
IL
1223G0001X
General Practice Dentistry
Primary
600206115
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2025
Last updated
08/10/2026
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