Provider Demographics
NPI:1619499480
Name:MERRITT, JESSICA JOLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JOLEEN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 HARVEST ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7114
Mailing Address - Country:US
Mailing Address - Phone:661-549-3075
Mailing Address - Fax:661-549-3075
Practice Address - Street 1:10350 FEDERAL BLVD UNIT 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260-8616
Practice Address - Country:US
Practice Address - Phone:303-427-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist