Provider Demographics
NPI:1134090293
Name:JESSER, MARI
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:JESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1548
Mailing Address - Country:US
Mailing Address - Phone:507-370-2343
Mailing Address - Fax:
Practice Address - Street 1:2300 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1548
Practice Address - Country:US
Practice Address - Phone:507-370-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002023942124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist