Provider Demographics
NPI:1003938242
Name:JESPERSEN, MARILYN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:B
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 S DE ANZA BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3025
Mailing Address - Country:US
Mailing Address - Phone:408-446-5789
Mailing Address - Fax:408-446-1447
Practice Address - Street 1:10430 S DE ANZA BLVD STE 290
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3025
Practice Address - Country:US
Practice Address - Phone:408-446-5789
Practice Address - Fax:408-446-1447
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics