Provider Demographics
NPI:1902521230
Name:CLOUGH, JESSICA DAWN (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21636-1126
Mailing Address - Country:US
Mailing Address - Phone:410-634-2380
Mailing Address - Fax:833-916-1014
Practice Address - Street 1:316 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1126
Practice Address - Country:US
Practice Address - Phone:410-634-2380
Practice Address - Fax:833-916-1014
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8876124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist