Provider Demographics
NPI:1104207299
Name:LEMOINE, JESSE (DDS)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:LEMOINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 RIVERPLACE BLVD APT 806
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9079
Mailing Address - Country:US
Mailing Address - Phone:508-315-2206
Mailing Address - Fax:
Practice Address - Street 1:530 BOSTON POST RD E STE D
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3645
Practice Address - Country:US
Practice Address - Phone:508-481-8094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDL237171223G0001X
NH048201223G0001X
MADN18580141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice