Provider Demographics
NPI:1891955522
Name:CARR, JESSE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:D
Last Name:CARR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1002
Mailing Address - Country:US
Mailing Address - Phone:402-372-2418
Mailing Address - Fax:
Practice Address - Street 1:122 W 6TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-2920
Practice Address - Country:US
Practice Address - Phone:402-362-3379
Practice Address - Fax:402-362-3370
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025157600Medicaid