Provider Demographics
NPI:1396441895
Name:GRANT, JESSICA EVAN (RDH (REGISTERED DENT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EVAN
Last Name:GRANT
Suffix:
Gender:F
Credentials:RDH (REGISTERED DENT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:EVAN
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411
Mailing Address - Country:US
Mailing Address - Phone:423-698-6005
Mailing Address - Fax:423-698-6410
Practice Address - Street 1:4601 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-698-6005
Practice Address - Fax:423-698-6410
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH0000008919124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist