Provider Demographics
NPI:1528224771
Name:DENTINGER, JESSICA ROSE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ROSE
Last Name:DENTINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NY
Mailing Address - Zip Code:14005-0002
Mailing Address - Country:US
Mailing Address - Phone:585-356-7653
Mailing Address - Fax:
Practice Address - Street 1:24 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036
Practice Address - Country:US
Practice Address - Phone:585-356-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist