Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DD11186 | MN |
NPI | 1659360543 |
---|---|
Provider Name | Jason Jenny |
First Address | Hastings, MN 55033-3734 |
Second Address | Hastings, MN 55033-3734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 08/07/2007 |