Provider Demographics
NPI:1669737219
Name:MAI, JENNIFER (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MAI
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 1:28527 TOMBALL PKWY
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4545
Mailing Address - Country:US
Mailing Address - Phone:713-623-1122
Mailing Address - Fax:281-907-8003
Practice Address - Street 1:28527 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4545
Practice Address - Country:US
Practice Address - Phone:713-623-1122
Practice Address - Fax:281-907-8003
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28160122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3728164-01Medicaid