Provider Demographics
NPI:1265695597
Name:TU, JENNY (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:TU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:221 CRESTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7707
Mailing Address - Country:US
Mailing Address - Phone:646-345-1164
Mailing Address - Fax:
Practice Address - Street 1:3735 DAVIS DR STE 125
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8907
Practice Address - Country:US
Practice Address - Phone:919-439-9998
Practice Address - Fax:919-439-6299
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490061223P0221X
NC89081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265695597Medicaid