MEDICARE: DR. JESSICA ROSE VO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DT-2909	HI
2	122300000X	Dentist	DT-2909	HI

General Provider Information

NPI Number	:	1023687324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA ROSE VO DMD

Provider Business Mailing Address
First Line	:	2525 DATE ST APT 2103
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-5413
Country	:	US
Telephone Number	:	808-693-5824
Fax Number	:

Provider Business Practice Location Address
First Line	:	98-1268 KAAHUMANU ST
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3257
Country	:	US
Telephone Number	:	808-486-4746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	02/20/2024

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