Provider Demographics
NPI:1154641652
Name:LE, JENNY HUANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:HUANG
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:XI JING
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-4732
Mailing Address - Country:US
Mailing Address - Phone:315-507-5181
Mailing Address - Fax:
Practice Address - Street 1:1625 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4732
Practice Address - Country:US
Practice Address - Phone:315-507-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049959-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313539Medicaid
NY01815443Medicaid
NY00313539Medicaid
NY334526Medicare Oscar/Certification