Provider Demographics
NPI:1912664384
Name:NITHALANGSY, JENNY DODOY (RDH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:DODOY
Last Name:NITHALANGSY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 KRONENWETTER DR APT 3
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-6203
Mailing Address - Country:US
Mailing Address - Phone:262-510-9104
Mailing Address - Fax:
Practice Address - Street 1:902 KRONENWETTER DR APT 3
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-6203
Practice Address - Country:US
Practice Address - Phone:262-510-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11405-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist