Individual
DR. JESSICA L HENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
228 E MAIN ST, EAST ISLIP, NY 11730-2711
(631) 581-8600
Mailing address
4 GAINSVILLE DR, PLAINVIEW, NY 11803-1210
(516) 364-2050
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
056072
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2011
Last updated
10/19/2015
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