Provider Demographics
NPI:1821040221
Name:DE JESUS, JENNIFER MAE (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:DE JESUS
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 1:911 E SAN ANTONIO DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2204
Mailing Address - Country:US
Mailing Address - Phone:562-984-6244
Mailing Address - Fax:
Practice Address - Street 1:911 E SAN ANTONIO DR
Practice Address - Street 2:SUITE 7
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2204
Practice Address - Country:US
Practice Address - Phone:562-984-6244
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist