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General NPI Number Information
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NPI Number | 1679752638
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Entity Type | Organization
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Legal Business Name | JESSICA L. MANSFIELD, DDS, PA
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 337 6TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-4301
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Country | US
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Telephone | 321-723-5244
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Fax | 321-723-9455
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Provider Business Mailing Address
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Address Line | 337 6TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-4301
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Country | US
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Telephone | 321-723-5244
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Fax | 321-723-9455
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA L MANSFIELD
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Credential | D.D.S.
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Telephone | 321-723-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN14331
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License Number State | FL
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