Provider Demographics
NPI:1356404479
Name:SCHWARZ, JESSIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:JESSIE
Other - Middle Name:SCHWARZ
Other - Last Name:NEWHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2825 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-453-0123
Mailing Address - Fax:310-453-0130
Practice Address - Street 1:2825 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-0123
Practice Address - Fax:310-453-0130
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist