MEDICARE: DR. JESSICA FRANCES SUAREZ 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
1	122300000X	Dentist	7045	NE
2	122300000X	Dentist	08927	IA

General Provider Information

NPI Number	:	1093060519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA FRANCES SUAREZ DDS

Provider Business Mailing Address
First Line	:	14826 FOWLER AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-1465
Country	:	US
Telephone Number	:	402-213-2407
Fax Number	:

Provider Business Practice Location Address
First Line	:	11110 FORT ST STE 106
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-2183
Country	:	US
Telephone Number	:	402-492-8300
Fax Number	:

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	10/30/2012

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