Provider Demographics
NPI:1336719830
Name:DANDRIDGE, JALEESA BRIGHT (DMD)
Entity Type:Individual
Prefix:
First Name:JALEESA
Middle Name:BRIGHT
Last Name:DANDRIDGE
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 1:1863 HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8877
Mailing Address - Country:US
Mailing Address - Phone:601-859-7050
Mailing Address - Fax:
Practice Address - Street 1:1863 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8877
Practice Address - Country:US
Practice Address - Phone:601-859-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4223-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist