Provider Demographics
NPI:1427186204
Name:MORIN, JESSICA WALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WALL
Last Name:MORIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 SEVEN HILLS BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0524
Mailing Address - Country:US
Mailing Address - Phone:678-574-4837
Mailing Address - Fax:678-828-5409
Practice Address - Street 1:76 SEVEN HILLS BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0524
Practice Address - Country:US
Practice Address - Phone:678-574-4837
Practice Address - Fax:678-828-5409
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist