Provider Demographics
NPI:1659360543
Name:JENNY, JASON (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:JENNY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8480 WOODBURY XING STE 120
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9406
Mailing Address - Country:US
Mailing Address - Phone:651-358-7025
Mailing Address - Fax:517-391-4716
Practice Address - Street 1:8480 WOODBURY XING STE 120
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9406
Practice Address - Country:US
Practice Address - Phone:651-358-7025
Practice Address - Fax:517-391-4716
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDD111861223P0106X
MND111861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology