Provider Demographics
NPI:1811886989
Name:VAN VLIET, JESSICA (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:VAN VLIET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MCILVAINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:928 NW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:928 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4482
Practice Address - Country:US
Practice Address - Phone:352-332-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist