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General NPI Number Information
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NPI Number | 1164869616
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Entity Type | Individual
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Provider Name | JENNIFER JEAN MCHENRY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 1075 MAPLE ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1545
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Country | US
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Telephone | 734-454-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 WHETHERSFIELD LN APT. 35B
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-1847
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Country | US
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Telephone | 248-765-6875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020909
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License Number State | MI
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