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General NPI Number Information
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NPI Number | 1780250795
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Entity Type | Individual
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Provider Name | JESSICA LYNN PICKELL DDS
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Gender | Female
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 2127 W STATE ROAD 434
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City | LONGWOOD
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State | FL
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Zip | 32779-4983
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Country | US
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Telephone | 407-332-6060
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Fax | 407-332-8190
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Provider Business Mailing Address
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Address Line | 2127 W STATE ROAD 434
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City | LONGWOOD
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State | FL
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Zip | 32779-4983
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Country | US
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Telephone | 407-332-6060
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Fax | 407-332-8190
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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 | 019.033099
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License Number State | IL
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