Provider Demographics
NPI:1982080131
Name:LIMCHOA, JENNY (DDS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LIMCHOA
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 1:124 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7537
Mailing Address - Country:US
Mailing Address - Phone:248-732-9582
Mailing Address - Fax:
Practice Address - Street 1:124 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7537
Practice Address - Country:US
Practice Address - Phone:248-732-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021295122300000X
NY0596521223P0700X
GADN1223251223G0001X, 1223P0700X
MND137851223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery