Provider Demographics
NPI:1629207428
Name:MINTON, JESSICA MERCEDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MERCEDES
Last Name:MINTON
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 1:210 CEDAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3201
Mailing Address - Country:US
Mailing Address - Phone:423-626-7070
Mailing Address - Fax:423-626-7060
Practice Address - Street 1:210 CEDAR FORK RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3201
Practice Address - Country:US
Practice Address - Phone:423-626-7070
Practice Address - Fax:423-626-7060
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist