Healthcare Provider Details

I. General information

NPI: 1396671368
Provider Name (Legal Business Name): JESSICA MARIE FUESSLEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E 4TH ST
VINTON IA
52349-1804
US

IV. Provider business mailing address

207 E 4TH ST
VINTON IA
52349-1804
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-3282
  • Fax:
Mailing address:
  • Phone: 319-472-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10500
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: