Provider Demographics
NPI:1053971861
Name:VAN HOOK, JENNIFER ROSE (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:VAN HOOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3573 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3043
Mailing Address - Country:US
Mailing Address - Phone:803-973-4530
Mailing Address - Fax:803-973-4533
Practice Address - Street 1:3573 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3043
Practice Address - Country:US
Practice Address - Phone:803-973-4530
Practice Address - Fax:803-973-4533
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165031223S0112X, 204E00000X, 390200000X
SCDGD.104401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery