Provider Demographics
NPI:1780250795
Name:PICKELL, JESSICA LYNN (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:PICKELL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 W STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4983
Mailing Address - Country:US
Mailing Address - Phone:407-332-6060
Mailing Address - Fax:407-332-8190
Practice Address - Street 1:2127 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4983
Practice Address - Country:US
Practice Address - Phone:407-332-6060
Practice Address - Fax:407-332-8190
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist