Provider Demographics
NPI:1982714531
Name:PLUMMER, JESS SHIRLEY (DDS)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:SHIRLEY
Last Name:PLUMMER
Suffix:
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 1:535 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3517
Mailing Address - Country:US
Mailing Address - Phone:316-321-4222
Mailing Address - Fax:316-321-3840
Practice Address - Street 1:535 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3517
Practice Address - Country:US
Practice Address - Phone:316-321-4222
Practice Address - Fax:316-321-3840
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS59051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice