Basic Information
| Provider Information | |||||||||
| NPI: | 1942860937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JESSON | ||||||||
| FirstName: | JENIFER | ||||||||
| MiddleName: | ESTHER | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24898 SANITARIUM DR | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923501717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406444016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5125 SKYWAY ROAD | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959695624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308722000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223G0001X | 104055 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.