Provider Demographics
NPI:1548083215
Name:DENHARTOG, JESSICA (RDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DENHARTOG
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 1:241 SMOKEY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-3409
Mailing Address - Country:US
Mailing Address - Phone:423-519-2592
Mailing Address - Fax:
Practice Address - Street 1:1905 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5401
Practice Address - Country:US
Practice Address - Phone:865-983-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10330124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist