Provider Demographics
NPI:1104278217
Name:SEUBERT, JESSICA (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SEUBERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ZIRCON LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-3364
Mailing Address - Country:US
Mailing Address - Phone:952-210-0213
Mailing Address - Fax:
Practice Address - Street 1:525 ZIRCON LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-3364
Practice Address - Country:US
Practice Address - Phone:952-210-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015238122300000X
MND14310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist