Provider Demographics
NPI:1902464480
Name:TSENG, JESSICA (DMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TSENG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2407
Mailing Address - Country:US
Mailing Address - Phone:925-247-4476
Mailing Address - Fax:
Practice Address - Street 1:1155 N CAPITOL AVE STE 160
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2559
Practice Address - Country:US
Practice Address - Phone:408-272-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist