Provider Demographics
NPI:1447944350
Name:WEN, JESSICA MIN HUI
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MIN HUI
Last Name:WEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1940
Mailing Address - Country:US
Mailing Address - Phone:651-325-8866
Mailing Address - Fax:
Practice Address - Street 1:16 JUNCTION DR W STE 101
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2996
Practice Address - Country:US
Practice Address - Phone:618-228-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist