Provider Demographics
NPI:1518257294
Name:DEAN, JESSICA ANN (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BISCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:972-498-4143
Mailing Address - Fax:972-498-8228
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-238-1848
Practice Address - Fax:972-238-8735
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334654602Medicaid
TX334654601Medicaid
TX350189YK5BMedicare PIN
TX350189YKQJMedicare PIN