Provider Demographics
NPI:1235422312
Name:HESS, JEREMY (DDS)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HESS
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 1:6677 CROSSINGS DR SE STE 4
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7889
Mailing Address - Country:US
Mailing Address - Phone:616-871-9604
Mailing Address - Fax:
Practice Address - Street 1:6677 CROSSINGS DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7889
Practice Address - Country:US
Practice Address - Phone:616-656-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010203871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice