Provider Demographics
NPI:1497961593
Name:JESSUP, RONALD JOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOE
Last Name:JESSUP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:J
Other - Last Name:JESSUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PC
Mailing Address - Street 1:1165 JEFFERSON GREEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-379-7864
Mailing Address - Fax:804-379-4295
Practice Address - Street 1:1165 JEFFERSON GREEN CIRCLE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-379-7864
Practice Address - Fax:804-379-4295
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist