Provider Demographics
NPI:1144890575
Name:DINH, JESSICA (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DINH
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 1:244 WITCH HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-6979
Mailing Address - Country:US
Mailing Address - Phone:864-430-9506
Mailing Address - Fax:
Practice Address - Street 1:1724 STATE RD UNIT 4D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2842
Practice Address - Country:US
Practice Address - Phone:843-376-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99251223G0001X
CA1110891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice