Provider Demographics
NPI:1326162041
Name:JESSEE, STEPHEN ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:JESSEE
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 1:4515 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5801
Mailing Address - Country:US
Mailing Address - Phone:713-500-4277
Mailing Address - Fax:713-500-4108
Practice Address - Street 1:6516 JOHN FREEMAN ST STE 493
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4277
Practice Address - Fax:713-500-4108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice