Provider Demographics
NPI:1871688580
Name:WOODHOUSE, JESSICA ELAINE BOLANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELAINE BOLANDER
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 N MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-0001
Mailing Address - Country:US
Mailing Address - Phone:317-846-6125
Mailing Address - Fax:317-846-6282
Practice Address - Street 1:9310 N MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-0001
Practice Address - Country:US
Practice Address - Phone:317-846-6125
Practice Address - Fax:317-846-6282
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010728A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200524690Medicaid