Provider Demographics
NPI:1831349232
Name:JESSICA C. NIEVA DDS P.C.
Entity type:Organization
Organization Name:JESSICA C. NIEVA DDS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NIEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-326-7633
Mailing Address - Street 1:552 OLD SMIZER MILL RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3538
Mailing Address - Country:US
Mailing Address - Phone:636-326-7633
Mailing Address - Fax:
Practice Address - Street 1:552 OLD SMIZER MILL RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3538
Practice Address - Country:US
Practice Address - Phone:636-326-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016551305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization