Provider Demographics
NPI:1730160698
Name:EUGENIO, JESSICA JANE (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:EUGENIO
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 1:130 STONECREST RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8126
Mailing Address - Country:US
Mailing Address - Phone:502-633-1584
Mailing Address - Fax:502-633-1509
Practice Address - Street 1:130 STONECREST RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8126
Practice Address - Country:US
Practice Address - Phone:502-633-1584
Practice Address - Fax:502-633-1509
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist