Provider Demographics
NPI:1518126911
Name:PESSOA, JODI-ANNE NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:JODI-ANNE
Middle Name:NICOLE
Last Name:PESSOA
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 1:1187 DRUID WALK
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3736
Mailing Address - Country:US
Mailing Address - Phone:301-906-1535
Mailing Address - Fax:
Practice Address - Street 1:1187 DRUID WALK
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3736
Practice Address - Country:US
Practice Address - Phone:301-906-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice