Provider Demographics
NPI:1326301144
Name:KELLER, JESSICA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:D
Last Name:KELLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:DOMBROSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3416 WOODLAWN STREET
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860
Mailing Address - Country:US
Mailing Address - Phone:804-458-6733
Mailing Address - Fax:804-541-0416
Practice Address - Street 1:3416 WOODLAWN STREET
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860
Practice Address - Country:US
Practice Address - Phone:804-458-6733
Practice Address - Fax:804-541-0416
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19726122300000X
VA0401414614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist