Provider Demographics
NPI:1184296527
Name:JONES, JESSIE RACHELLE (DMD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:RACHELLE
Last Name:JONES
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 1:2249 NEW PORT VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9387
Mailing Address - Country:US
Mailing Address - Phone:801-691-6355
Mailing Address - Fax:
Practice Address - Street 1:1580 PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9783
Practice Address - Country:US
Practice Address - Phone:262-618-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002636-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist