Provider Demographics
NPI:1447938741
Name:CROLLEY, JENNIFER (RDH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CROLLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12828 RAMSGATE CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9021
Mailing Address - Country:US
Mailing Address - Phone:409-365-8284
Mailing Address - Fax:
Practice Address - Street 1:6425 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2158
Practice Address - Country:US
Practice Address - Phone:317-255-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13008912A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist