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General NPI Number Information
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NPI Number | 1043109374
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Entity Type | Individual
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Provider Name | JESSE ELLIOTT BISSELL DDS
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Gender | Female
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 5877 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3741
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Country | US
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Telephone | 323-759-1523
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 978-380-2082
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 111843
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License Number State | CA
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