Provider Demographics
NPI:1154851863
Name:GEURKINK, JESSICA BREE (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BREE
Last Name:GEURKINK
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 1:625 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4201
Mailing Address - Country:US
Mailing Address - Phone:817-491-1900
Mailing Address - Fax:
Practice Address - Street 1:17200 CHENAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5958
Practice Address - Country:US
Practice Address - Phone:501-448-0032
Practice Address - Fax:501-448-0068
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist