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General NPI Number Information
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NPI Number | 1407263247
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Entity Type | Individual
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Provider Name | JESSICA JILL WATERBURY DDS
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 1926 COLLEGEVIEW RD E HC 116
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City | ROCHESTER
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State | MN
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Zip | 55904-8201
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Country | US
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Telephone | 507-258-4046
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Fax |
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Provider Business Mailing Address
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Address Line | 1926 COLLEGEVIEW RD E HC 116
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City | ROCHESTER
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State | MN
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Zip | 55904-8201
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Country | US
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Telephone | 507-258-4046
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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 | D13437
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License Number State | MN
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