Provider Demographics
NPI:1649889965
Name:WEST, JESS P JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JESS
Middle Name:P
Last Name:WEST
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SCARBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5594
Mailing Address - Country:US
Mailing Address - Phone:980-200-6576
Mailing Address - Fax:
Practice Address - Street 1:12180 US-601 SOUTH
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107
Practice Address - Country:US
Practice Address - Phone:704-781-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice