Provider Demographics
NPI:1255803938
Name:MORGAN, JESSICA NCIOLE (RDHAP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NCIOLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WIMBLEDON LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4476
Mailing Address - Country:US
Mailing Address - Phone:209-321-9659
Mailing Address - Fax:
Practice Address - Street 1:42 WIMBLEDON LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4476
Practice Address - Country:US
Practice Address - Phone:209-321-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist