Provider Demographics
NPI:1790143592
Name:LANG, JESSICA CHEVERTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CHEVERTON
Last Name:LANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:CHEVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:543 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3073
Mailing Address - Country:US
Mailing Address - Phone:434-665-0424
Mailing Address - Fax:
Practice Address - Street 1:543 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3073
Practice Address - Country:US
Practice Address - Phone:434-665-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0593461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty