Provider Demographics
NPI:1104207299
Name:LEMOINE, JESSE (DDS)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:LEMOINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVERSIDE AVE UNIT 537
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4986
Mailing Address - Country:US
Mailing Address - Phone:508-315-2206
Mailing Address - Fax:
Practice Address - Street 1:2797 SAINT JOHNS BLUFF RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3703
Practice Address - Country:US
Practice Address - Phone:904-641-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18580141223P0300X
NH048201223P0300X
TX344571223P0300X
FLDN237171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics