Provider Demographics
NPI:1144955485
Name:POPA, JESSICA ALEXANDRA (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ALEXANDRA
Last Name:POPA
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 1:3329 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3315
Mailing Address - Country:US
Mailing Address - Phone:216-398-8900
Mailing Address - Fax:
Practice Address - Street 1:3329 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3315
Practice Address - Country:US
Practice Address - Phone:216-398-8900
Practice Address - Fax:216-741-3131
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0269371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice