Healthcare Provider Details

I. General information

NPI: 1598513509
Provider Name (Legal Business Name): JENNA ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210B S MAIN ST
MIDDLETON MA
01949-3302
US

IV. Provider business mailing address

99 KNEELAND ST APT 1801
BOSTON MA
02111-2447
US

V. Phone/Fax

Practice location:
  • Phone: 978-623-4590
  • Fax:
Mailing address:
  • Phone: 330-749-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN10000391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: