Provider Demographics
NPI:1881866192
Name:MONDESTIN, JESSIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:MONDESTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SILAS CREEK PKWY
Mailing Address - Street 2:SUITE 576
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3031
Mailing Address - Country:US
Mailing Address - Phone:336-768-8228
Mailing Address - Fax:
Practice Address - Street 1:3320 SILAS CREEK PKWY
Practice Address - Street 2:SUITE 576
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3031
Practice Address - Country:US
Practice Address - Phone:336-768-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist