MEDICARE: DR. JESSIKA ELIZABETH MARTIN D.D.S.

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	202892	CO

General Provider Information

NPI Number	:	1235580291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIKA ELIZABETH MARTIN D.D.S.

Provider Business Mailing Address
First Line	:	15455 GLENEAGLE DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2593
Country	:	US
Telephone Number	:	719-354-2472
Fax Number	:	719-368-8548

Provider Business Practice Location Address
First Line	:	15455 GLENEAGLE DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2593
Country	:	US
Telephone Number	:	719-354-2472
Fax Number	:	719-368-8548

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

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	04/05/2021

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