Provider Demographics
NPI:1932774056
Name:PIEPENBRINK, JESSICA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:PIEPENBRINK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2850 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5308
Mailing Address - Country:US
Mailing Address - Phone:309-786-7782
Mailing Address - Fax:
Practice Address - Street 1:2850 24TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5308
Practice Address - Country:US
Practice Address - Phone:309-786-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0030991223X0400X
IADDS-098421223X0400X
IL019.0318221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics