Jengo, Peter
Jengo, Peter is an individual health care provider with primary practice located at 175 Connors Street , Gardner MA 01440. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Jengo, Peter can be contacted via phone (978) 410-6100.Contact Information
Primary practice address
175 Connors Street
Gardner MA 01440
Phone: (978) 410-6100
Fax: (978) 410-6176
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 10648 | Massachusetts |
Profile Details
| NPI number | 1205985553 |
|---|---|
| LBN Legal business name | Jengo, Peter |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 9th, 2007 |
| Last updated | Aug 18th, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205985553 | NPPES |
| Massachusetts | MEDICAID | 0212270 |
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