Provider Demographics
NPI:1922338565
Name:THOMAS, JESS TAYLOR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:TAYLOR
Last Name:THOMAS
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:N94W17900 APPLETON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-8022
Mailing Address - Country:US
Mailing Address - Phone:262-251-6820
Mailing Address - Fax:262-251-8081
Practice Address - Street 1:N84W15994 MENOMONEE AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3036
Practice Address - Country:US
Practice Address - Phone:262-251-6820
Practice Address - Fax:262-251-8081
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2015-12-22
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Provider Licenses
StateLicense IDTaxonomies
WI6375-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics