Provider Demographics
NPI:1164096053
Name:LAMPASI, JESSICA BAYER (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BAYER
Last Name:LAMPASI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 SE RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6446
Mailing Address - Country:US
Mailing Address - Phone:909-222-2946
Mailing Address - Fax:
Practice Address - Street 1:2111 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5213
Practice Address - Country:US
Practice Address - Phone:580-699-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4467124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist