Provider Demographics
NPI:1760742472
Name:TOMBERLIN, JESSICA WIEDEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WIEDEY
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1781 TATE BLVD SE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4251
Mailing Address - Country:US
Mailing Address - Phone:828-855-3779
Mailing Address - Fax:828-855-3781
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:SUITE 204
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4251
Practice Address - Country:US
Practice Address - Phone:828-855-3779
Practice Address - Fax:828-855-3781
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC93171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice