Provider Demographics
NPI:1184874141
Name:LOUMEAU, JESSICA GINDELE (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:GINDELE
Last Name:LOUMEAU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GINDELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1699 S 14TH ST STE 21
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1965
Mailing Address - Country:US
Mailing Address - Phone:904-277-8500
Mailing Address - Fax:
Practice Address - Street 1:1699 S 14TH ST STE 21
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1965
Practice Address - Country:US
Practice Address - Phone:904-277-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice