Provider Demographics
NPI:1245487859
Name:JOHNSON, JESSICA BROOKE (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROOKE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BROOKE
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1111 9TH ST STE 190
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2527
Mailing Address - Country:US
Mailing Address - Phone:515-244-9136
Mailing Address - Fax:515-244-9153
Practice Address - Street 1:1111 9TH ST STE 190
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2527
Practice Address - Country:US
Practice Address - Phone:515-244-9136
Practice Address - Fax:515-244-9153
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA84861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice