Provider Demographics
NPI:1063824886
Name:NEESE, JENNIFER ASHLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:NEESE
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 1:1650 W OAK ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1962
Mailing Address - Country:US
Mailing Address - Phone:317-873-8902
Mailing Address - Fax:
Practice Address - Street 1:1650 W OAK ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1962
Practice Address - Country:US
Practice Address - Phone:317-873-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012134A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist