Provider Demographics
NPI:1265319735
Name:DERUSHA, JESSICA SPEARS (RDH)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SPEARS
Last Name:DERUSHA
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 1:200 CARELLTON DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1426
Mailing Address - Country:US
Mailing Address - Phone:615-406-7372
Mailing Address - Fax:
Practice Address - Street 1:615 COMMONS DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6318
Practice Address - Country:US
Practice Address - Phone:615-230-6611
Practice Address - Fax:615-230-6614
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6161124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist