Provider Demographics
NPI:1770922940
Name:WALBURN, JENNA BEHRENTS (DMD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:BEHRENTS
Last Name:WALBURN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LAUREN
Other - Last Name:BEHRENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14710 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223
Mailing Address - Country:US
Mailing Address - Phone:913-529-8636
Mailing Address - Fax:
Practice Address - Street 1:14710 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223
Practice Address - Country:US
Practice Address - Phone:913-529-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0087541223G0001X
KS61944122300000X, 1223X0400X
MO20170043561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist