Provider Demographics
NPI:1134402662
Name:THORNTON, JESSAMY JAE (DDS)
Entity type:Individual
Prefix:
First Name:JESSAMY
Middle Name:JAE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JESSAMY
Other - Middle Name:JAE
Other - Last Name:STENGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1821 SHAY LIN CT
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4530
Mailing Address - Country:US
Mailing Address - Phone:402-326-9302
Mailing Address - Fax:
Practice Address - Street 1:340 BOATNER RD, BLDG 2751
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-883-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program