Provider Demographics
NPI:1932958212
Name:HANG, JENNA (DMD, MPH, MS)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HANG
Suffix:
Gender:F
Credentials:DMD, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 RIVERS BND APT 408
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3065
Mailing Address - Country:US
Mailing Address - Phone:661-317-9700
Mailing Address - Fax:
Practice Address - Street 1:2971 CHAPEL VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7420
Practice Address - Country:US
Practice Address - Phone:661-317-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001458-15122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist