Provider Demographics
NPI:1871709014
Name:NEVINS, JEANNIENE SHAREN (DDS)
Entity type:Individual
Prefix:MRS
First Name:JEANNIENE
Middle Name:SHAREN
Last Name:NEVINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15460 16 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RODNEY
Mailing Address - State:MI
Mailing Address - Zip Code:49342-9625
Mailing Address - Country:US
Mailing Address - Phone:231-832-5621
Mailing Address - Fax:231-832-5643
Practice Address - Street 1:1419 N. STATE ST.
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9749
Practice Address - Country:US
Practice Address - Phone:231-796-4409
Practice Address - Fax:231-796-2694
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI157201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice