Provider Demographics
NPI:1144613431
Name:MATTERN, JESSICA (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MATTERN
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 1:4846 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1640
Mailing Address - Country:US
Mailing Address - Phone:480-794-0302
Mailing Address - Fax:
Practice Address - Street 1:1516 JARRET PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2607
Practice Address - Country:US
Practice Address - Phone:718-405-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0305771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry