Provider Demographics
NPI:1144376542
Name:NUNEZ, JENNY V (DDS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:V
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2271
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-2271
Mailing Address - Country:US
Mailing Address - Phone:912-805-9267
Mailing Address - Fax:
Practice Address - Street 1:705 GREEN ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-5134
Practice Address - Country:US
Practice Address - Phone:912-805-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133211223G0001X
TNDS91211223G0001X
GADN157551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017535Medicaid