Healthcare Provider Details

I. General information

NPI: 1023861499
Provider Name (Legal Business Name): JESSICA SHORT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N SAINT JOSEPH AVE
MARSHFIELD WI
54449-1340
US

IV. Provider business mailing address

1307 N SAINT JOSEPH AVE
MARSHFIELD WI
54449-1340
US

V. Phone/Fax

Practice location:
  • Phone: 715-221-5700
  • Fax:
Mailing address:
  • Phone: 715-221-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6002055-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: