MEDICARE: JESSICA LYNNE ALTMIRE 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	061823	NY

General Provider Information

NPI Number	:	1538797980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNNE ALTMIRE DDS

Provider Business Mailing Address
First Line	:	1641 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1604
Country	:	US
Telephone Number	:	585-482-5504
Fax Number	:	585-482-5507

Provider Business Practice Location Address
First Line	:	1641 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1604
Country	:	US
Telephone Number	:	585-482-5504
Fax Number	:	585-482-5507

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	06/10/2024

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