Provider Demographics
NPI:1306283601
Name:GEORGE GANO, JESSICA LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:GEORGE GANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27023 N 55TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7335
Mailing Address - Country:US
Mailing Address - Phone:423-605-4464
Mailing Address - Fax:
Practice Address - Street 1:6435 ARGONNE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3903
Practice Address - Country:US
Practice Address - Phone:423-605-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD009423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program