Provider Demographics
NPI:1750540712
Name:TRI, JESSICA A (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:TRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1003
Mailing Address - Country:US
Mailing Address - Phone:651-463-7777
Mailing Address - Fax:651-460-6123
Practice Address - Street 1:213 1ST ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1003
Practice Address - Country:US
Practice Address - Phone:651-463-7777
Practice Address - Fax:651-460-6123
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist