Provider Demographics
NPI:1104499706
Name:SIN, JESSICA GRACE (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:GRACE
Last Name:SIN
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 1:728 CRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7826
Mailing Address - Country:US
Mailing Address - Phone:925-989-8361
Mailing Address - Fax:
Practice Address - Street 1:351 FELICE DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3361
Practice Address - Country:US
Practice Address - Phone:831-637-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice