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General NPI Number Information
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NPI Number | 1275041618
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Entity Type | Organization
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Legal Business Name | JESSICA JONES LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 913 MICHIGAN AVE
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City | SANTA MONICA
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State | CA
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Zip | 90404-4309
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Country | US
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Telephone | 310-970-4046
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Fax |
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Provider Business Mailing Address
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Address Line | 913 MICHIGAN AVE
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City | SANTA MONICA
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State | CA
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Zip | 90404-4309
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Country | US
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Telephone | 310-970-4046
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA ANN JONES
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Credential |
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Telephone | 310-970-4046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 545
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License Number State | CA
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