Provider Demographics
NPI:1245613934
Name:SNELLER, JESSICA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JEAN
Last Name:SNELLER
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:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:NEW ERA
Mailing Address - State:MI
Mailing Address - Zip Code:49446-0036
Mailing Address - Country:US
Mailing Address - Phone:231-861-5905
Mailing Address - Fax:
Practice Address - Street 1:4711 1ST ST
Practice Address - Street 2:
Practice Address - City:NEW ERA
Practice Address - State:MI
Practice Address - Zip Code:49446-5100
Practice Address - Country:US
Practice Address - Phone:231-861-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010216291223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice