Provider Demographics
NPI:1558711416
Name:TITHERINGTON, JESSICA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:TITHERINGTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 NW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6177
Mailing Address - Country:US
Mailing Address - Phone:561-246-7623
Mailing Address - Fax:
Practice Address - Street 1:13889 WELLINGTON TRCE STE A5
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8587
Practice Address - Country:US
Practice Address - Phone:561-935-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist