Provider Demographics
NPI:1659025427
Name:JOSHUA, JESSICA (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GULFSTREAM RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-9677
Mailing Address - Country:US
Mailing Address - Phone:912-965-6227
Mailing Address - Fax:
Practice Address - Street 1:200 GULFSTREAM RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-9677
Practice Address - Country:US
Practice Address - Phone:912-965-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH011827124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist