Provider Demographics
NPI:1518650100
Name:MCBRIDE, JESSICA J (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 COLONY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4686
Mailing Address - Country:US
Mailing Address - Phone:804-243-2634
Mailing Address - Fax:
Practice Address - Street 1:14431 SOMMERVILLE CT STE A
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6812
Practice Address - Country:US
Practice Address - Phone:804-794-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014184431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program