Provider Demographics
NPI:1104054220
Name:CREWS, JESSICA TUNSTILL (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TUNSTILL
Last Name:CREWS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:TUNSTILL
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3600 CARDINAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5581
Mailing Address - Country:US
Mailing Address - Phone:904-737-4626
Mailing Address - Fax:
Practice Address - Street 1:3600 CARDINAL POINT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5581
Practice Address - Country:US
Practice Address - Phone:904-737-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics