Provider Demographics
NPI:1508965997
Name:GUY, JESSICA ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:GUY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:KWASNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX C9
Mailing Address - Street 2:
Mailing Address - City:SWIFTWATER
Mailing Address - State:PA
Mailing Address - Zip Code:18370-9732
Mailing Address - Country:US
Mailing Address - Phone:570-839-3972
Mailing Address - Fax:
Practice Address - Street 1:175 E BROWN ST
Practice Address - Street 2:CACH/VALERIE M.HODGE MEMORIAL DENTAL CENTER, SUITE 114
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-476-3506
Practice Address - Fax:570-421-9014
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0362401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019757410002Medicaid
PA1659974OtherUNITED CONCORDIA PROVIDER
238786OtherUNISON
2027012OtherUNITED CONCORDIA/GATEWAY
PA1019757410001Medicaid
105985OtherDORAL