Healthcare Provider Details

I. General information

NPI: 1083874333
Provider Name (Legal Business Name): JENNIFER LYNN HENKIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 MIDDLE COUNTRY RD
SELDEN NY
11784-2504
US

IV. Provider business mailing address

330 E 38TH ST APT 54D
NEW YORK NY
10016-9804
US

V. Phone/Fax

Practice location:
  • Phone: 631-732-0233
  • Fax:
Mailing address:
  • Phone: 305-409-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number056544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: