Provider Demographics
NPI:1760719652
Name:TUNG, JENNIFER PATRICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PATRICIA
Last Name:TUNG
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 1:16510 CLEVELAND ST STE Q
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4439
Mailing Address - Country:US
Mailing Address - Phone:425-882-1112
Mailing Address - Fax:
Practice Address - Street 1:16510 CLEVELAND ST STE Q
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4439
Practice Address - Country:US
Practice Address - Phone:425-882-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist