Provider Demographics
NPI:1821332479
Name:WILLIAMS, JESSICA LEE (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NEW HAVEN ST APT B
Mailing Address - Street 2:APT B
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-2212
Mailing Address - Country:US
Mailing Address - Phone:814-440-6870
Mailing Address - Fax:
Practice Address - Street 1:1685 CROWN AVE
Practice Address - Street 2:#200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6322
Practice Address - Country:US
Practice Address - Phone:717-481-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH069789124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist