Provider Demographics
NPI:1497866875
Name:MACKEY, JENNIFER LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:DEOJAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:423 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3812
Mailing Address - Country:US
Mailing Address - Phone:860-449-8330
Mailing Address - Fax:
Practice Address - Street 1:423 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3812
Practice Address - Country:US
Practice Address - Phone:860-449-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT93121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice