Provider Demographics
NPI:1518443118
Name:JANSEN, JOSEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEE
Middle Name:
Last Name:JANSEN
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 1:320 SINGLETON BLVD APT 1114
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-4155
Mailing Address - Country:US
Mailing Address - Phone:712-301-4439
Mailing Address - Fax:
Practice Address - Street 1:2030 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5815
Practice Address - Country:US
Practice Address - Phone:712-301-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice