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NPI Code Detail

MEDICARE: DR. JESSICA LETTELLEIR DDS

MEDICARE: DR. JESSICA LETTELLEIR DDS
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
1122300000XDentistD14731MN

General Provider Information

NPI Number : 1073252367
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA LETTELLEIR DDS
Provider Business Mailing Address
First Line : 4131 26TH ST NW STE 1
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-8342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4131 26TH ST NW STE 1
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-8342
Country : US
Telephone Number : 507-282-8082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2022
Last Update Date : 06/03/2022

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