Provider Demographics
NPI:1548522691
Name:PUSHEE, JESSICA LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:PUSHEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOXBOROUGH BLVD
Mailing Address - Street 2:#9205
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035
Mailing Address - Country:US
Mailing Address - Phone:774-269-1200
Mailing Address - Fax:
Practice Address - Street 1:400 FOXBOROUGH BLVD
Practice Address - Street 2:#9205
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:774-269-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist