Provider Demographics
NPI:1598184871
Name:ULMER, JESSICA BROWN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROWN
Last Name:ULMER
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 CHASTANT ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2053
Mailing Address - Country:US
Mailing Address - Phone:504-455-1625
Mailing Address - Fax:504-455-7604
Practice Address - Street 1:4429 CHASTANT ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2053
Practice Address - Country:US
Practice Address - Phone:504-455-1625
Practice Address - Fax:504-455-7604
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics