Provider Demographics
NPI:1467592295
Name:JESSUP, EVA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:LYNN
Last Name:JESSUP
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 1:2221 CLEARVIEW PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2481
Mailing Address - Country:US
Mailing Address - Phone:504-455-1667
Mailing Address - Fax:504-455-1783
Practice Address - Street 1:2221 CLEARVIEW PKWY STE 202
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2481
Practice Address - Country:US
Practice Address - Phone:504-455-1667
Practice Address - Fax:504-455-1783
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice