Provider Demographics
NPI:1821797176
Name:ROCKWELL, JESSICA LINDLEY (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LINDLEY
Last Name:ROCKWELL
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 1:214 EARLY DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-7101
Mailing Address - Country:US
Mailing Address - Phone:865-924-5187
Mailing Address - Fax:
Practice Address - Street 1:6230 HIGHLAND PLACE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4036
Practice Address - Country:US
Practice Address - Phone:865-584-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8761124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist