Provider Demographics
NPI:1619397999
Name:REICHARD, JESSICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:REICHARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHRZANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25575 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4049
Mailing Address - Country:US
Mailing Address - Phone:440-835-8999
Mailing Address - Fax:
Practice Address - Street 1:25575 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4049
Practice Address - Country:US
Practice Address - Phone:440-835-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.0245961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program