Provider Demographics
NPI:1821189176
Name:CONRAD, JESSICA N (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:N
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:N
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:760 US HWY 206
Mailing Address - Street 2:STE 2
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1506
Mailing Address - Country:US
Mailing Address - Phone:908-359-6521
Mailing Address - Fax:908-359-4557
Practice Address - Street 1:760 US HWY 206
Practice Address - Street 2:STE 2
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1506
Practice Address - Country:US
Practice Address - Phone:908-359-6521
Practice Address - Fax:908-359-4557
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHI00869400124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist