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General NPI Number Information
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NPI Number | 1659360543
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Entity Type | Individual
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Provider Name | JASON JENNY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 8480 WOODBURY XING STE 120
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City | WOODBURY
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State | MN
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Zip | 55125-9406
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Country | US
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Telephone | 651-358-7025
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Fax | 517-391-4716
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Provider Business Mailing Address
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Address Line | 8480 WOODBURY XING STE 120
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City | WOODBURY
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State | MN
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Zip | 55125-9406
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Country | US
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Telephone | 651-358-7025
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Fax | 517-391-4716
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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 | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | DD11186
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D11186
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License Number State | MN
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