Provider Demographics
NPI:1598076283
Name:POMERANTZ, JESSICA MISCHLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MISCHLER
Last Name:POMERANTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAURA
Other - Last Name:MISCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 8TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3563
Mailing Address - Country:US
Mailing Address - Phone:919-360-0928
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-789-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice