Provider Demographics
NPI:1255729083
Name:JOSEPH, JESSICA JAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JAYNE
Last Name:JOSEPH
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 1:1136 GARDEN ST
Mailing Address - Street 2:APT 2
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4354
Mailing Address - Country:US
Mailing Address - Phone:862-202-9708
Mailing Address - Fax:
Practice Address - Street 1:177 GORDONHURST AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1722
Practice Address - Country:US
Practice Address - Phone:973-744-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025718001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice