MEDICARE: JESSICA CARON RHODES D.M.D

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	019029631	IL

General Provider Information

NPI Number	:	1447687249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CARON RHODES D.M.D

Provider Business Mailing Address
First Line	:	4555 N RAVENSWOOD AVE STE 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5201
Country	:	US
Telephone Number	:	312-766-9395
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 N RAVENSWOOD AVE STE 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5201
Country	:	US
Telephone Number	:	312-766-9395
Fax Number	:

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

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	05/07/2021

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