Provider Demographics
NPI:1538454517
Name:MASSIE, JESSICA CLAIRE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CLAIRE
Last Name:MASSIE
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:1551 WEALTHY ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2766
Mailing Address - Country:US
Mailing Address - Phone:616-330-1123
Mailing Address - Fax:616-330-1125
Practice Address - Street 1:1551 WEALTHY ST SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2766
Practice Address - Country:US
Practice Address - Phone:616-330-1123
Practice Address - Fax:616-330-1125
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2901020874122300000X, 1223P0221X
IL019.0285931223G0001X
IL021.0024261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice