Provider Demographics
NPI:1073125746
Name:JESSICA MATTERN DDS, PLLC
Entity Type:Organization
Organization Name:JESSICA MATTERN DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-794-0302
Mailing Address - Street 1:4126 N LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1742
Mailing Address - Country:US
Mailing Address - Phone:480-794-0302
Mailing Address - Fax:
Practice Address - Street 1:326 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2363
Practice Address - Country:US
Practice Address - Phone:480-794-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty