Provider Demographics
NPI:1528735438
Name:CASPER, JESSICA LEIGH (LDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:CASPER
Suffix:
Gender:F
Credentials:LDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55777 WYNNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9517
Mailing Address - Country:US
Mailing Address - Phone:574-298-0911
Mailing Address - Fax:
Practice Address - Street 1:309 N BITTERSWEET RD # 105
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4220
Practice Address - Country:US
Practice Address - Phone:574-621-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13007317A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist