MEDICARE: MS. JESSICA LEE RDH

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	124Q00000X	Dental Hygienist	24641	TX

General Provider Information

NPI Number	:	1730836081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA LEE RDH

Provider Business Mailing Address
First Line	:	904 CEDAR TER
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-4790
Country	:	US
Telephone Number	:	585-483-2306
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 MCCART AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7427
Country	:	US
Telephone Number	:	585-483-2306
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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