Provider Demographics
NPI:1902016017
Name:SY-MUNOZ, JENNY TAN (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:TAN
Last Name:SY-MUNOZ
Suffix:
Gender:F
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 FARBER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5773
Mailing Address - Country:US
Mailing Address - Phone:716-633-7070
Mailing Address - Fax:716-633-2595
Practice Address - Street 1:531 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5773
Practice Address - Country:US
Practice Address - Phone:716-633-7070
Practice Address - Fax:716-633-2595
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051911-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics